{"paper_id":"5a330586-80fb-495c-9dca-c7ac536737a6","body_text":"Interprofessional Simulation Based Training for Obstetric and Neonatal Emergencies: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Interprofessional Simulation Based Training for Obstetric and Neonatal Emergencies: A Systematic Review Manini Bhatia, Kelly Zhou, Jainil Shah, Elisha Purcell, Arunaz Kumar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6344547/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Interprofessional (IP) simulation-based training (SBT) is a very important tool for enhancing multidisciplinary teamwork when managing obstetric and neonatal emergencies and emergencies in any medical speciality. While current evidence supports the role of IP SBT in improving practitioner collaboration and patient outcomes, systematic reviews to date have focused on SBT within individual specialties. We aimed to systematically review the prevalence and effectiveness of combined IP SBT in the management of obstetric and neonatal emergencies globally. METHODS We conducted a systematic search of several databases (PubMed, EMBASE, CINAHL, MEDLINE) for relevant articles. Our search focused on looking at combined obstetric and neonatal IP SBT in a clinical education setting from inception to October 2024. The Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-1) tool was used to perform a risk of bias assessment for quantitative studies. The Joanna Briggs Institute (JBI) checklist was used risk of bias assessment of qualitative studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to assess the certainty of available evidence. RESULTS We found 6374 articles in our initial systematic search. Following screening, 40 studies met the inclusion criteria, involving healthcare professionals from 18 countries. The type of SBT programs varied, with the Obstetrics and Neonatal Emergency Simulation (ONE-Sim) program being the most common, reported in 7 studies. Other programs included Simulation and Team Training for Obstetric and Neonatal Emergencies (PRONTO), Enhancing Training and Technology for Mothers and Babies in Africa (ETATMBA) and Practical Obstetric Multi-Professional Training (PROMPT). The simulation programs usually consisted of several obstetric and neonatal emergency simulation scenarios which were followed by participant debrief. The included studies reflected on the simulation environment, practitioner reported outcomes such as clinician skills, leadership, knowledge, confidence, interprofessional teamwork, clinical and organisational outcomes. Using the GRADE approach there was an overall moderate certainty of evidence for the effectiveness of SBT in obstetric and neonatal emergencies. CONCLUSION This review supports the need for increased availability and provision of IP SBT training across the globe. Despite current studies showing benefit in enhancing clinician skills, patient outcomes and organisational performance, the evidence on SBT programs for managing obstetric and neonatal emergencies remains limited and requires further research and implementation. Emergency medical education neonatology obstetrics skills training Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Simulation is becoming a key part of training of healthcare professionals who are involved in managing both obstetric and neonatal emergencies across the globe. In clinical practice, such emergencies are often attended to by multidisciplinary teams, which include doctors, midwives, nurses, students and other observers or helpers. We need appropriately trained clinicians to be available and prepared to provide effective emergency care with skill and confidence. Moreover, it is widely acknowledged that poor IP teamwork and communication during obstetric emergencies are some of the biggest contributors to maternal death ( 1 – 5 ). The effectiveness of SBT programs in team-based interventions has already been established in a large number of non-medical fields including aviation, military and education ( 1 , 6 – 8 ). Rakshasbhuvankar (2014) showed that SBT improves resuscitation scores and decreases the time it takes to achieve resuscitation steps, likely resulting in safer care and preventing risk ( 5 ). Managing obstetric and neonatal emergencies in an integrated manner often requires simultaneous resuscitation of both the mother and the newborn, highlighting the need for comprehensive global IP SBT programs. However, most current SBT programs are unfortunately limited by their focus on teamwork within a single profession or on specific types of emergencies. This is usually either obstetric or neonatal care alone, rather than together. This is a significantly limited approach because it does not support the nuanced management of complex real-life emergency situations which require cohesive responses from several interdisciplinary professionals. The World Health Organization (WHO) defines interprofessional education (IPE) as education that happens when ‘students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes’ ( 9 ). This systematic review is the first to assess how providing IP SBT can impact on the management of obstetric and neonatal emergencies worldwide. Our team provides a review on the prevalence and effectiveness of IP SBT by analysing outcomes of practitioners, patients and health services using both qualitative and quantitative tools. Through conducting this review, we hope to enhance availability, simulation design and implementation of IP SBT on a global scale. METHODS The aim of this review was to investigate the prevalence and effectiveness of IP SBT in managing combined obstetric and neonatal emergencies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( 10 ) were followed when preparing and compiling this review. We registered our protocol on PROSPERO prospectively (CRD42024591980). CRITERIA FOR SELECTION Study types We considered all publications and study designs to be eligible for this review. Only studies where the full text was available in English were included. Certain types of research and publications such as literature reviews, discussion pieces, conference abstracts, editorials and protocols were not included in our systematic review. Participants IP SBT was defined in our review as training that involved healthcare workers from at least two of the following disciplines: medical, nursing, midwifery, or other relevant areas and we ensured that our included studies investigated IP SBT in this context. An exception to this definition was made for health care facilities across the globe that were staffed solely by skilled birth attendants (SBAs). Simulation/intervention types Included studies were required to focus on both obstetric and neonatal emergencies, which we defined as emergencies related to labour and the birthing process. For example, simulation of post-partum haemorrhage (PPH) was included, while management of antenatal conditions like gestational diabetes was not. Inclusion and exclusion criteria are documented in Table 1 . Table 1 Inclusion and Exclusion Criteria Inclusion Criteria Exclusion Criteria ● Studies that focus on obstetric and neonatal emergencies ● Must involve interprofessional simulation-based training ● Full article accessible in English ● Available electronically ● Literature reviews, discussion pieces, conference abstracts, editorials, protocols ● Antenatal emergencies ● Neonatal emergencies outside of the birthing process Outcomes Outcomes related to the simulation environment, clinician self-reported outcomes, participant outcomes and organisational outcomes were accepted and reported on. SYSTEMATIC SEARCH A systematic database search was conducted of articles that explored the use of obstetric and neonatal IP SBT in PubMed, EMBASE, CINAHL and MEDLINE from inception to March 2023 by author KZ initially. To be sure of relevancy and recency of our search and that newer studies were also included, we repeated the search strategy again in October 2024 (KZ), closer to the completion date of our systematic review. We did not filter for language or publication date in both the searches. Our search strategy is outlined in detail below in Table 2 . Table 2 Search Strategy Databases Search Strings Date performed PubMed EMBASE CINAHL MEDLINE ((((doc* OR nurs* OR midwi* OR student) AND (team* OR interprofessional OR interdisciplinary OR multidisciplinary)) AND (obste* OR birth OR delivery OR labor OR newborn OR neonat*)) AND (emergenc* OR crisis OR resus*)) AND (simulat* OR train* OR drill OR educat*) March 2023 October 2024 STUDY CHOICE AND DATA COLLECTION PROCESS We used the Covidence Systematic Review Software to assist us with the study selection process. Covidence is a systematic review management platform that is operated by Veritas Health Innovation Ltd in Melbourne, Victoria, Australia. The compiled studies from the various databases were exported into the Covidence software with automatic removal of duplicated files. A manual deduplication was then subsequently repeated by authors JS and KZ to make sure all the duplicated studies had been appropriately removed. JS and KZ then individually screened the titles and abstracts and removed any studies that did not meet the inclusion criteria. Several studies were also considered ineligible in this process based on our exclusion criteria. JS and KZ then independently reviewed and performed full-text screening on the remaining studies to analyse in more detail if they met our inclusion criteria. Third reviewer MB resolved conflicts for any studies where JS and KZ had a differing opinion on whether the study met the selection criteria. This process resulted in a total of 40 included studies. JS and KZ then individually took the relevant data from these studies and placed it into a table in a Microsoft Excel spreadsheet. Our team followed the usual data extraction process that is suggested by The Cochrane Handbook ( 11 ). RISK OF BIAS AND CERTAINTY OF EVIDENCE The ROBINS-I tool was used to assess risk of bias in quantitative studies ( 12 ) and the JBI critical appraisal tool was used to assess risk of bias in qualitative studies ( 13 )., Two review authors (JS, KZ) individually performed the risk of bias assessment for each study and any conflicts were resolved by third review author (MB). We chose the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to review the certainty of evidence ( 14 ). RESULTS A PRISMA flow diagram (Fig. 1 ) obtained from Covidence summarises our selection process for studies as described above. The initial database search provided 6374 studies which were exported into Covidence. 1840 studies were excluded by removing duplicates, leaving 4534 studies. Of these, 4278 studies were removed in the title and abstract screening stage. This left 256 studies for which full papers available in English were obtained. JS and KZ independently performed full text screening on these 256 articles, and MB (a third reviewer) resolved any conflicts. After further excluding another 216 studies, this left a total of 40 studies for the final data extraction. ( 15 – 54 ). Table 3 summarises important aspects of these selected studies including (but not limited to) SBT duration, content, country, disciplines involved, and main reported outcomes. Table 3 Summary of included studies Place in text: Line 218, page 9 Abbreviation Full title AC Associate clinician AHW Allied Health Workers AROM Acute rupture of membranes BCU Biocontainment Unit BLS Basic Life Support CI Confidence interval CORE Combined Obstetrics Resuscitation and Emergencies Training Project CS Caesarean section CTS Clinical teamwork scale HPS High-fidelity human patient simulation IFH Impacted foetal head LDHF Low Dose High Frequency MCA Maternity Care Assistant MEC Maternity emergency course NKLM National Competence Based Learning Objectives Catalogue for Medicine NICU Neonatal intensive care unit NPC Non physician clinician OB-STaT Obstetrics Simulation Training and Teamwork O&G Obstetrics and Gynaecology ONE-Sim Obstetrics and Neonatal Emergency Simulation OSCE Objective Structured Clinical Exam PROMPT Practical Obstetric Multi-Professional Training RAN Remote Area Nurses RN Registered Nurse SBA Skilled birth attendant SCN Special Care Nursery SCORPIO Structured, Clinical, Objective Referenced, Problem-oriented, Integrated, and Organized STT Simulation and Team Training First author, year Population Size Disciplines Involved Simulation Training Program Emergency Scenarios Simulated Study Objective Training Structure/Duration Measure(s) of Effect Participant Outcome(s) Clinical Outcome(s) Adams et al, 2024 USA 78 Medical residents, nursing students - PPH, Pre/Eclampsia, Neonatal Resuscitation, Perimortem CS, Shoulder Dystocia Demonstrate feasibility of clinical training program 5 x 15 mins simulations (and 10 min debrief each) 1 Skills Station Post-training survey − 92.9% reported training as useful - Afulani et al, 2020 Ghana 43 Midwives, doctors, nurses Respectful Maternity Care (modified PRONTO) 5 Scenarios from: PPH, antepartum haemorrhage, intrapartum haemorrhage, neonatal resuscitation, shoulder dystocia, cord prolapse, breech, pre-eclampsia/eclampsia, sepsis, preterm labour/birth Determine effectiveness of program on provider knowledge and self-efficacy - Post-Training Survey, Knowledge Tests and Interviews - Increased knowledge and self-efficacy scores (p < 0.001) - 95% participants reported training as useful - Anderson et al, 2005 UK 228 Midwives, obstetricians, paediatricians, anaesthetists, theatre staff, health care assistants Fire drills, classroom-based emergency training sessions Massive obstetric haemorrhage, shoulder dystocia, eclampsia, maternal and neonatal resuscitation, cord prolapse, breech delivery A postal survey to ascertain whether labour wards in England and Wales are conducting drills, and if so, how they are organised and evaluated Fortnightly, monthly or 3–4 times a year. Postal questionnaire - Of the 185 units that were interviewed, 95 centres (51%) were conducting ‘fire drills’ - Bhatia et al, 2023 India 160 Medical and Nursing Students ONE-Sim Normal and obstructed labour, shoulder dystocia, PPH, neonatal resuscitation To analyse undergraduate medical/nursing students’ situational awareness during ONE-Sim 3-3.5 hours course Pre and post training surveys - Participants reported improved environmental perception, protocol and situation specific knowledge, prioritisation and teamwork skills - Dettinger et al, 2018 Kenya 182 Medical officers, clinical officers, nurses PRONTO Normal birth, uterine atony, placenta praevia, cervical laceration, incomplete abortion, neonatal resuscitation, shoulder dystocia with severe PPH, preeclampsia, eclampsia Measure impact of PRONTO training on knowledge, self-efficacy and teamwork self-assessment 3-day program Pre and post training knowledge tests, self-efficacy and teamwork surveys - Improvements in knowledge, self-efficacy and teamwork (p < 0.0001) - Ellard et al, 2014 Malawi 54 NPCS/ACS ETATMBA Project - Malawi External cephalic version, vaginal breech, PPH, B lynch suture, shoulder dystocia, eclampsia, vacuum extraction, obstructed labour Evaluate implementation of ETATMBA and changes to practice 6 modules across 30 months post-module interviews - Trainees reported cascading of knowledge onto peers, implementation of new knowledge and skills, and confidence in initiating changes in practice - Ellard et al, 2016 Tanzania 36 NPCS/ACS ETATMBA Project - Tanzania Not Specified Explore impact of ETATMBA on maternal/neonatal health outcomes 16-week training program Examination of pre/post-intervention maternal/neonatal health indicators, survey of health facilities in rural Tanzania - - Non-significant downward trend in maternal deaths over 2 years - No significant differences in maternal/neonatal/birth complication variables across time points - Surveys revealed shortages in key areas (e.g. availability of running water, ambulances) Gomez et al, 2018 Ghana 403 SBAs (registered/certified Midwives) LDHF Training PPH, neonatal resuscitation, pre-Eclampsia/eclampsia To assess the effect of LDHF training approach on long-term evidence-based skill retention amongst skilled birth attendants and impact on adverse birth outcomes 2 x 4-day sessions Relative risks of institutional intrapartum stillbirths and 24h newborn mortality in months 1–6, 7–12 (compared to historical cohort period), Pre/Post Intervention Knowledge Tests - After 1 year, 200 SBAs assessed had 28% (95% CI 25–32; p < 0·001) and 31% (95% CI 27–36; p < 0·001) higher scores than baseline on low-dose 1 and 2 content skills, respectively - Sustained decrease in facility-based 24h newborn mortality and intrapartum stillbirth (p < 0·001) Greer et al, 2023 USA 721 O&G/anaesthetics/paediatrics attendings/residents, certified obstetric/neonatal/midwifery nurses, certified/student anaesthetic nurses, navy hospital corpsmen, blood bank personnel, operating room personnel OB-STaT PPH, maternal/neonatal resus, Impact of OB-STaT on participant PPH treatment and maternal/neonatal resuscitation knowledge and teamwork 4-hour program Pre-training and post-training knowledge test, teamwork assessment (CTS), patient perception score - Obstetricians trainees and attendings significantly improved knowledge test scores (p < 0.01) - Improvement in overall mean CTS scores (p < 0.01) - Hirst et al, 2009 Vietnam 58 Midwifery/obstetric/neonatal service providers SCORPIO teaching method PPH, neonatal resuscitation To evaluate the SCORPIO multidisciplinary teaching program to improve maternal and infant health 3-day workshop post-training anonymous feedback forms - Workshops rated either good or excellent overall by all participants - Participants reported that the content would help with clinical work and teaching was easy to understand - Khot et al, 2022 India 160 Medical and nursing students ONE-Sim (Online) Shoulder dystocia (with neonatal resuscitation) and PPH To evaluate key learning acquired by undergraduate medical/nursing students from the online ONE-Sim workshops 2-hour workshop Electronic questionnaires - Participants reported on themes of cognitive presence (e.g. Information exchange and reflective discourse), social presence (e.g. communicating vulnerability, collaboration) and teacher/educator presence (e.g. stepped learning, repetition) - Kildea et al, 2006 Australia 175 RAN’s, AHW’s, RN’s, student nurses, enrolled nurses MEC course PPH, neonatal resuscitation, breech birth, cord prolapse, shoulder dystocia The evaluation aimed to assess the overall impact of the course on participants’ knowledge, and their perception of the benefits to their own practice 2.5 day workshop Post-intervention questionnaire Evaluations demonstrate a highly valued program, well received and supported by remote health staff. Themes included: increase in confidence and a decrease in fear of childbearing women; increasing the participants’ understanding of maternity conditions - Kogutt et al, 2019 USA 16 Obstetricians, labour and delivery nurses/technicians, neonatologist, neonatal nurse practitioner, NICU respiratory therapists, NICU nurses, BCU nurses - Neonatal resus To test the ability of the Johns Hopkins Hospital BCU to manage a pregnant patient in labour with an unknown respiratory illness and to deliver and stabilize her neonate without biocontamination 2-hour workshop Objective measures to detect contamination, After-action reporting - No evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise - Valuable insights regarding patient transportation, patient care, specialized equipment considerations, safety and PPE, obstetric and neonatal considerations, and communication - Kumar et al, 2018 Australia 508 Medical staff/ students (obstetricians, paediatricians, anaesthetists), midwifery staff/students, SCN staff PROMPT - Victorian state version PPH, neonatal resuscitation, eclampsia, shoulder dystocia Evaluate the implementation of the PROMPT simulation on participant acquisition of knowledge/skills, impact on clinical outcomes and organisational change to integrate PROMPT as a credentialling tool Half day programme 1) Pre-test/post-test paper-based questionnaires - Participants reported improvement in clinical and non-technical skills (teamwork, communication, leadership, prioritisation) in emergency situations - Key learning themes include being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment - Kumar et al, 2019 India 150 Doctors, midwives, medical students, midwifery students ONE-Sim (Mobile) Obstructed labour, breech birth, shoulder dystocia, PPH, neonatal resus of asphyxiated infant Identify challenges and effectiveness of implementing ONE-Sim program 6-day course Pre/post-workshop qualitative surveys - Participants reported key learning points were gaining knowledge and procedural skills, non-technical skills, a systematic approach to obstetric and neonatal emergencies and learning in teams - Kumar et al, 2021 India 48 Note: This is a follow up to the Kumar 2019 study ↑ ↑ To evaluate participant attitudes, perceptions of retention of learning, and application to clinical practice one year after a simulation workshop ↑ 12 month follow up: Post-workshop up one-to-one interviews - Participants reported enhanced leadership skills, effective learning in interprofessional teams, improved procedural skills - Li et al, 2024 Singapore 280 O&G trainees (150), family medicine / anaesthesia / emergency trainees (112), nurses / midwives ( 28 ) CORE and CORE Lite Severe pre-eclampsia, PPH, breech delivery, maternal resuscitation, shoulder dystocia, uterine inversion and twin delivery Audit to compare the confidence levels of participants in the management of obstetric emergencies based on their responses in the pre- and post-course questionnaires. Not reported Confidence Scores Overall significant increase in confidence levels among participants in the management of obstetric emergencies post-simulation course (p < 0.01) - Lutgendorf et al, 2017 USA 113 Obstetric residents, midwives, labour and delivery nurses, corpsmen, anaesthesia providers - PPH Assess participant comfort with managing obstetric haemorrhage following our multidisciplinary in situ simulation training exercise 2-day course Pre/post simulation participant self-reported comfort levels - Participants reported higher comfort level in managing obstetric emergencies such as hypertensive emergencies, shoulder dystocia, PPH after simulation training - A decrease in the time to prepare simulated blood products over the course of the simulation was observed - A decreasing trend of PPH cases (which continued after initiating the postpartum haemorrhage simulation exercise) Madden et al, 2011 Northern Ireland 200 Midwives, paediatricians, anaesthetists, obstetricians, resuscitation officers, laboratory staff, other hospital staff - PPH, cardiac arrest, cord prolapse, shoulder dystocia To investigate the effect of on-site, multi-professional simulated emergency drills on teamwork Not reported Repeated observation/compilation of written notes Three main themes emerged: collaboration, communication and control. In every simulation exercise category post-evaluation analysis demonstrated effective change - Malhotra et al, 2021 Australia, overseas (not specified) > 400 - One-Sim (Online) Obstructed labour, foetal distress, neonatal resuscitation and PPH Some important lessons that were learned from the preliminary experience of these ONE-Sim workshops are detailed in this report 2.5-3.5-hour workshops Preliminary experience/observations The online workshops were well received by students and staff in Australia and overseas - Meekeret al, 2018 USA 170 Labour and Delivery RN, Special Care Nursery RN, surgical technician, anaesthesiologist, certified RN anaesthetist, obstetrics resident/attending, paediatrics attending HPS Shoulder dystocia, newborn resuscitation, maternal seizure, maternal resuscitation To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies 2 hours per simulation Post workshop participant surveys - Participants reported improved communication (p = .031) and teamwork (p = .041) after simulation. - Additionally, 81% of respondents believed that their ability to perform clinical skills improved. - Miller et al, 2008 USA 700 Physicians, nurses, support staff - Placental abruption, uterine rupture, PPH To describe the experiential nature of in situ simulation for the participants Not reported Post-workshop (debriefing) self-reported participant/facilitator experiences - Participant evaluation provided insight into the communication lapses and team failures - Miller et al, 2023 Uganda, Kenya 318 Nurse midwife (55%), nurse (24%), clinical officer (11%), medical officer (7%), other (5%) PRONTO, STT Pre-eclampsia, PPROM, spontaneous preterm delivery (with chorioamnionitis of a floppy/non-vigorous baby) To understand how STT trainings impacted preterm birth knowledge and skill of providers Variable Pre and post training knowledge tests, clinical skills and teamwork assessment - Improved knowledge scores, communication techniques and preterm birth evidence-based practices - Monod et al, 2014 Switzerland 168 Midwives, obstetricians - shoulder dystocia, PPH, pre-eclampsia, maternal BLS, neonatal resuscitation, operative vaginal birth To investigate the influence of simulation training on four specific skills: self-confidence, handling of emergency situation, knowledge of algorithms and team communication 1 day course Post-training questionnaire - Participants gave higher Likert scale answers for questions on the four specific skills after 3mo (compared to immediately after the course). - The improvement was statistically significant ( p ≤ 0.05) except for team communication. - Pak et al, 2015 USA Not reported Trauma attending/fellow/residents, obstetric attending/residents/RN’s, NICU attending/fellow/RN’s, neonatal respiratory therapist - Pregnant trauma patient: adult resus, neonatal resuscitation, emergency CS To identify patient safety risks, a multidisciplinary in situ simulation drill was conducted that involved physicians and nurses from different specialties including trauma, obstetrics, neonatal intensive care, and emergency care. Not reported Post-training debriefing As a result of the drill, three patient safety concerns were identified by ED nursing staff including: a lack of familiarity of equipment and supplies, poor communication, and poor documentation. - Pauley et al, 2016 England 36 Midwives, paramedics, MCA’s, student midwives - PPH, neonatal resuscitation, shoulder dystocia, cord prolapse, breech To assess the effectiveness of planned skill drills in the community Half-day training session Post-training evaluation forms Positive response from participants who reported the simulation a more realistic environment for this workforce than that offered by hospital-based training - Prasad et al, 2020 Australia (Online) 71 Medical and midwifery students ONE-Sim (Online) PPH, neonatal resuscitation, shoulder dystocia To understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions 65 mins Preliminary observations of facilitators Researchers observe students reacting positively to online simulation with collaborative interactions, asking facilitators questions and sharing previous experiences / knowledge amongst each other - Prasad et al, 2022 Australia (Online) 385 Medical and midwifery students ONE-Sim (Online) PPH, Neonatal Resuscitation, Shoulder Dystocia To explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops 85 mins Post-training survey - Main themes from participant responses were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. - Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. - Midwifery students were most interested in interprofessional interaction whilst medical students were more concerned with developing clinical skills - Rosenberg et al, 2021 Rwanda 20 Midwives, nurses, physicians EONC Prolapsed umbilical cords, delivery of twins, breech delivery, shoulder dystocia, and newborn resuscitation Develop and implement a context-specific prehospital obstetrics and neonatal course for SAMU based on international best practices and form an instructor core for prehospital obstetrics education in the region by implementing a train-the-trainers program and studying the outcomes 2-day course (EONC1, EONC2) Pre/post training 50 question assessment EONC1 median scores were 60% versus 92% (pre vs post), using matched-pair analysis of 20 participants. EONC2 median scores were 52% versus 96% (pre vs post), using matched-pair analysis of participants. A one-way analysis of variance mean square analysis showed that regardless of the baseline level of training for each participant, all trainees reached similar post-course assessment scores (F( 1 ) = 8.35, P = 0.0059) - Shaw-Battista et al, 2015 USA Not reported 3rd/4th year medical students, 1st/2nd year midwifery students, obstetric residents, paediatrics residents / advanced practice nurses, family medicine residents / advanced practice nurses - Foetal bradycardia, cord prolapse following AROM with high vertex, shoulder dystocia, PPH We developed our curriculum with these critical components in mind and describe this ongoing project as an exemplar for educators and clinical leaders, with an overview of challenges and successes to inform adaptation to other settings Not reported Qualitative researcher preliminary observations Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings - Stieglitz et al, 2023 Germany 174 Medical students (160), midwifery students ( 14 ) - Shoulder dystocia To demonstrate how the learning objectives for shoulder dystocia, listed in the National Competence Based Learning Objectives Catalogue for Medicine (NKLM, Germany) can be successfully taught in medical studies using a blended learning concept (e-learning One hour eLearning course Evaluation form and learning objectives 95.9% of the study participants met the required standards, i.e. achieved very good to adequate performance in simulation training. - Van der Scheer et al, 2023 United Kingdom 57 21 midwives, 25 obstetricians, 7 anaesthetists and 4 other professionals from five maternity units. - Impacted foetal head at CS birth To evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams. Up to 3 hours Post-training feedback in focus groups - Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH. - Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5% 92%agreement with the pre-training statements) but improved in nearly all participants after the training (71–100% agreement with the post-training statements). - Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners. - Varghese et al, 2016 India 50 Obstetrics and newborn care providers (medical doctors, labour room nurses) - PPH, eclampsia, birth asphyxia Tested the feasibility, acceptability, and effectiveness of a “skills and drills” intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India 2-day clinical skills refresher sessions + emergency drills (45mins each x once every 2mo) Delivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCE’s), and qualitative in-depth interviews Knowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49–57% (P = .006) and in newborn care, scores increased from 48–56% (P = .03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P < .001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care. - Walker et al, 2014b Mexico 450 Generalist physicians, specialist physicians (obstetricians, paediatricians, anaesthesiologist, surgeons, neonatologist, perinatologist, internists), nurses PRONTO Obstetrics haemorrhage, pre-eclampsia Assess the impact of PRONTO simulation training on process indicators 3-day modules 1) Pre/post-training knowledge, self-efficacy, 2) Teamwork scores 3) Achievement of strategic planning goals established during trainings - Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p < 0.001–0.009) in all domains. - Teamwork scores improved and were maintained over a three-month period. - A mean of 58.8% strategic planning goals per team in each hospital were achieved - Walker et al, 2015 Guatemala 219 Auxiliary nurses, doctors, professional nurses, \"other\" PRONTO Obstetric haemorrhage, neonatal resuscitation, shoulder dystocia, pre-eclampsia/eclampsia Impact of PRONTO on provider knowledge and self-efficacy 5 months Pre-training and post-training assessment and interview - Improvement in knowledge and self-efficacy scores (p < 0.001) - Walker et al, 2016 Mexico 219 Auxiliary nurses, doctors, professional nurses, \"other\" PRONTO Obstetric haemorrhage, neonatal resuscitation, shoulder dystocia, pre-eclampsia/eclampsia Impact of PRONTO on patient outcomes 5 months Follow up neonatal mortality, maternal complications, and caesarean delivery rates - - Significant estimated impact of PRONTO on the incidence of caesarean sections (reduction) in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P = 0.005) and in intervals measured at 4 (16% decrease, P = 0.02), 8 (20% decrease, P = 0.004), and 12 months’ (20% decrease, P = 0.003) follow-up Walton et al, 2016 Guatemala Not specified Not specified PRONTO Normal Birth, uterine atony, placenta praevia, cervical laceration, incomplete abortion, neonatal resus, shoulder dystocia with severe PPH, pre/eclampsia To assess the effect of PRONTO on non-emergency delivery practices at primary level clinics in Guatemala. 3-day modules Implementation of practices known to decrease maternal and/or neonatal mortality and improve patient care Overall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labour was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P = 0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P < 0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P = 0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P = 0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P = 0.012) - Wu et al, 2024 China 23 Obstetricians ( 3 ), midwives ( 20 ) - Gentle birth, episiotomy on model of the perineum, shoulder dystocia, neonatal asphyxia resuscitation, emergency caesarean section, postpartum hemorrhage, and preeclampsia with seizures To explore the effects of simulation-based midwife training workshops and determine whether such a program can improve team collaboration and communication. 2-day simulation training Clinical Teamwork Scale (CTS) The total median score of all items was significantly higher in the post-training group (median, 7.0 range, 4.0–9.0) than in the pre-training group (median, 5.0; range, 4.0–6.0; p = 0.002). - Zech et al, 2017 Mexico 270 Obstetricians, gynaecologists, anaesthesiologists, nursing staff, neonatologists, midwives Simparteam PPH due to uterine atony, shoulder dystocia, uterine rupture during vaginal delivery, placental abruption (with floppy infant due to asphyxia), meconium aspiration syndrome (with pneumothorax), neonatal sepsis To evaluate whether the standardised simulation-based training program “simparteam” for multiprofessional obstetric teams can improve staff’s self-perceived emergency management skills and indirectly even affect the patient safety culture in hospitals that differ regarding the size and care level 12 hours (over 1.5 days) Pre/post-training questionnaires Strong effects were found in the participants’ perception of their own competence regarding technical skills and handling of emergencies - Zhong et al, 2021 India 125 Nurses, obstetric/neonatal doctors, students, \"other health professionals involved during childbirth) ONE-Sim Normal and obstructed labour, breech birth, shoulder dystocia, PPH, neonatal resus (asphyxiated newborn) Assessing contribution of ONE-Sim workshop in management of obstetrics and neonatal emergencies, as perceived by participants. 4 days Pre-workshop and post-workshop qualitative surveys - Increased confidence in ability to manage emergency scenarios - Improving individual and synergistic performance in teams - TYPES OF INTERPROFESSIONAL SBT PROGRAMS There were several different SBT programs identified in the studies with the majority (n = 14) not following a specific program name. From the remainder, the most reported training programs included variations of the Obstetrics and Neonatal Emergency Simulation (ONE-Sim) (n = 7) program, the Simulation and Team Training for Obstetric and Neonatal Emergencies (PRONTO) program (n = 6) and the Enhancing Training and Technology for Mothers and Babies in Africa (ETATMBA) program (n = 2). There was a significant variation in the duration and structure of training across these programs, including 65–120 minute online workshops, longer simulation modules or mentorships and training sessions provided at various intervals over several months. There were a wide variety of obstetric and neonatal emergencies simulated across programs including but not limited to the management of PPH (n = 27), shoulder dystocia (n = 25), neonatal resuscitation (n = 22) and pre/eclampsia (n = 13). The programs involved IP SBT sessions where team members engaged in a simulated emergency scenario and were subsequently given performance feedback from senior medical, nursing or midwifery staff. In some studies, local clinicians were taught how to deliver IP SBT programs within their own facilities. Post intervention data was mainly qualitative, consisting of post training surveys and questionnaires. A limited number of studies examined the impact of clinical outcomes, however, given their small number and heterogeneity we could not perform a meta-analysis. LOCATIONS The Global Distribution of IP SBT programs is presented in Fig. 2 . The IP SBT programs reported were spread across 18 different countries across all major continents. These included centres in Asia (n = 9), Europe (n = 5), Oceania (n = 5), North America (n = 13) and Africa (n = 8). The highest number of reported studies by country was in the USA (n = 8), India (n = 6) and Australia (n = 5) respectively. PARTICIPANTS Across the 40 studies, individuals from 18 countries were participated in IP SBT programs, coming from a range of different occupations and training levels. Participants included health professionals directly involved during childbirth (Obstetricians, Neonatologists, Paediatricians, Nurses and Midwives) as well as other health professionals such as General Practitioners, Anaesthesiologists, Internal Medicine Specialists and Allied Health staff (Paramedics, Army Corpsman and Respiratory Therapists). Ten SBT programs also recruited non-clinical staff including blood bank and operating room personnel, navy corpsmen and other hospital staff. In ETATMBA SBT sessions, an additional role of Non-Physician Clinicians (NPCs) or Associate Clinicians (ACs) was identified. This describes trained clinicians present in many African nations with medical and nursing skills who look after women and newborns in regional and rural centres ( 20 – 21 ). The exact number of individuals within each discipline participating in the IP SBT sessions varied across the 40 studies. Overall, the most frequently participating clinician group was medical professionals (n = 26 studies), followed closely by nurses (n = 20 studies) and midwifery staff (n = 20 studies). The facilitators of these IP SBT sessions also varied in their level of skill and expertise in SBT provision. Clinical experience of participants ranged from senior registered practitioners (consultants and fellows) to student trainees. THE SIMULATION ENVIRONMENT A realistic and safe simulation environment in the IP SBT training programs was noted across the included studies. In particular, Kumar (2021) highlighted that by realistically mimicking clinical practice in a controlled setting participants could strengthen their learnt skills, feel more comfortable and less rushed ( 28 ). Wu (2024) also commented on how participants felt less judged in a simulation setting compared to other training methods or programs ( 52 ). Four of the included studies conducted online simulation workshops, rather than face to face in person sessions. In Malhotra (2021) there was an overall positive response to online SBT training from both clinicians and students across the globe, with a focus on its benefit during the COVID-19 pandemic ( 34 ). Feeling connected, or ‘connectivism’ was mentioned in a number of studies and it was seen as an important concept that allowed participants to engage with the provided learning ( 25 , 34 , 41 , 42 ). Malhotra (2021) additionally noted that participants felt that watching livestreamed scenarios appeared to be more effective than watching pre-recorded scenarios during online workshops ( 34 ). Multiple factors were thought to impact on the efficacy of the various simulation programs implemented in the 40 studies. These included (but were not limited to) the type of workshop, the type of simulation, timing of simulation sessions and the role of debrief. Certain workshops like PRONTO were used across multiple studies. Walker (2015) suggests that the PRONTO program showed such strong results and was so well received in Guatemala that it got further funding to expand IP SBT provision to other facilities beyond those that were initially planned ( 50 ). Rosenberg (2021) reflects that the EONC course, taught by local stakeholders, leant itself to creating interdisciplinary connections between prehospital providers and their hospital colleagues, with relation to obstetric and neonatal emergencies ( 43 ). Walker (2014) preferred high fidelity simulation whilst Miller (2023) found that low fidelity simulation training that was focused on clinical mentorship, communication and teamwork was also helpful, in addition to being less costly ( 37 , 48 ). Finally, Shaw-Battista (2015) noted that IP SBT participation can be optimised when scenarios have a clinical picture that requires multidisciplinary input ( 44 ). They also suggested that there is likely to be more uptake if such training sessions occur at the time of shift change or have roles for both students and clinicians ( 44 ). CLINICIAN SELF REPORTED OUTCOMES Clinician self-reported outcomes included teamwork and collaboration, confidence, preparedness for practice, communication, knowledge, debriefing and a shared mental model. Across the studies, the single most recurrent theme was the role of IP SBT in improving teamwork. Miller (2008) suggests that teams make less mistakes compared to individuals ( 36 ). They also highlight that task training allows individuals to learn how to perform high quality work independently but team training enables individuals to see and develop the behaviours that are required to work effectively in an IP setting ( 36 ). Participating clinicians reported that following IP SBT they more clearly understood the basics of teamwork ( 16 , 35 , 48 ). Anderson (2005) commented that doing multidisciplinary acute obstetric emergency drill training made it easier for the participants to visualise how they would realistically work together if an actual emergency were to occur ( 17 ). Kumar (2021) noted that participants appreciated being able to work together as a team, better understand each other’s roles and provide others with support, moving away from a culture where help seeking was seen as failure ( 28 ). Madden (2011) noted that individuals were good at communicating within their own professional team, but not as good at communicating with participants from other clinical areas or teams ( 33 ). For example, the midwife had to repeatedly communicate the same message to various professionals from different disciplines as they arrived to a scenario and due to this poor IP communication there were delays in care provision ( 33 ). Pauley (2016) recognised the importance of interdisciplinary obstetric and neonatal management outside the hospital, extending to the role of paramedics. Being present in obstetric and neonatal IP SBT scenarios was thought to provide paramedics with a better understanding of what inpatient teams felt was helpful prior hospital arrival ( 40 ). Van der Scheer (2023) showed that IP SBT allowed all interprofessional team members to better appreciate each other’s challenges and recognise what they could do to help, thereby raising awareness amongst participants that managing emergency obstetric and neonatal conditions requires a well-integrated multidisciplinary team ( 46 ). Two studies specifically showed an increase in clinician confidence in managing obstetric emergencies ( 30 , 31 ). This partly resulted from participants having more a more comprehensive understanding of their surroundings, greater familiarity with local protocols and equipment and a learned process to synthesise a more systematic approach. Self-efficacy improved through situational awareness, with Bhatia (2023) suggesting that practitioners become more situationally aware through SBE ( 18 ). Technical skills also improved, with Zech (2017) noting that participating in IP SBT resulted in a long term skill acquisition, which was sustained at 6 months on some occasions in their study ( 53 ). Preparedness for practice was an important clinician self-reported theme that emerged in this systematic review. Anderson (2005) discussed how practicalities such as the equipment on the labour ward being organised in a better manner, placement of laminated protocols in each delivery room, presence of more accessible telephones, and individuals knowing where the defibrillator or eclampsia box was located helped practitioners feel more prepared ( 17 ). Kumar (2018) notes that IP SBT prepared participants for complex situations like eclampsia, neonatal resuscitation, shoulder dystocia in addition to learning the relevant pathways of care escalation at their service in an emergency ( 30 ). Gaining knowledge was an important part of IP SBT. For example, Adams (2024) reports that the most useful topics covered in their IP SBT sessions were neonatal resuscitation, maternal resuscitation, preeclampsia and eclampsia ( 15 ). Afulani (2020) showed that there were improvements in post-test scores on topics like neonatal resuscitation, maternal and neonatal sepsis, placenta praevia, preeclampsia and eclampsia ( 16 ). Meeker (2018) showed that 81% of their participants who completed survey responses felt that their clinical performance in an emergency improved following attendance of IP SBT training ( 35 ). Finally, Miller (2023) showed that following PRONTO simulation and team training there was a statistically significant improvement in knowledge scores from 51-72.6% (p < 0.01) when comparing the pre and post intervention multiple choice test responses in the neonatal, maternal and communication question categories ( 37 ). Management algorithms and debriefing were two other important areas reported on. Van der Scheer (2023) suggested that management algorithms were useful in allowing IP teams to build a shared mental model and allowed those who entered the theatre later to quickly establish the situation ( 46 ). Finally, Miller (2008) reported that debriefing within the IP team allowed individuals to learn by doing, and established ‘active failures’ or ‘latent conditions’ present in the simulated setting that could contribute to improper management in real emergencies ( 36 ). Reflections from debriefing in Miller (2008) also played a role in developing an IP training curriculum for teams ( 36 ). Ultimately, effective IP SBT led to an improvement in a number of clinician reported domains across the 40 included studies. PATIENT AND ORGANISATIONAL OUTCOMES Patient outcomes documented in the included studies were newborn mortality, intrapartum stillbirth, active management of third stage, need for caesarean section and postpartum haemorrhage. A meta-analysis was not conducted in this review as quantitative outcomes were difficult to measure across the studies, with a significant number of qualitative studies being included. Organisational outcomes included a better understanding of specialised equipment, personal protective equipment (PPE) training, reflections on transportation, protocol development and provision of informed and safe practice. Walker (2014) promoted facility-based quality improvement as part of their SBE training ( 48 ). Malhotra (2021) demonstrated that using PPE and putting it on and removing it in the correct manner raised issues and questions with its use, and addressing these questions assisted with the development of team communication skills ( 34 ). A few studies highlighted the importance of changes that need to occur at a systems level. Other studies focused on identifying gaps in IP staff training and how these could be optimised. For example, in Lutgendorf (2017) it became apparent that not everyone involved in emergency scenarios knew the process to request and obtain emergency blood products which led to additional staff training in a timely manner ( 32 ). Improved understanding and development ( 17 , 32 , 43 ) of protocols that led to improved patient outcomes was discussed in several studies as well. Varghese (2016) highlighted a number of organisational challenges identified through IP SBT including an inadequate number of trained staff, a rotating nursing workforce and inconsistencies in the drugs and supplies available for clinical practice ( 47 ). All in all, IP SBT highlighted patient and organisation factors that could be addressed to improve obstetric and neonatal care provision globally. RISK OF BIAS Risk of bias assessment was completed using the ROBINS-1 tool for quantitative non-randomised studies (16 studies) and the JBI tool for qualitative studies (24 studies). The number of quantitative and qualitative studies is summarised in Table 4 . The qualitative studies were all included using the JBI checklist. For the quantitative studies the ROBINS-1 tool showed that overall, 9 studies were associated with moderate risk of bias and 6 studies were associated with serious risk of bias as seen in Fig. 3 . The main area of concern was bias in the measurement of outcomes with an overall moderate to serious level of bias across the included studies in this domain. Table 4 – Overview of quantitative and qualitative studies Place in text: Line 379, page 14 Article (Author, Publication Year) Study Type Outcome Risk of Bias Tool Adams 2024 Unsure/Mixed Surveys JBI Afulani 2020 Quantitative Knowledge; Self-Efficacy ROBINS-I Anderson, 2005 Qualitative Questionnaires JBI Bhatia, 2023 Quantitative Surveys JBI Dettinger, 2018 Quantitative Knowledge; Self-Efficacy; Teamwork ROBINS-I Ellard, 2014 Qualitative Interviews JBI Ellard, 2016 Quantitative Maternal/Neonatal Health Indicators ROBINS-I Gomez, 2018 Quantitative Neonatal Mortality ROBINS-I Greer, 2023 Quantitative Knowledge; Teamwork ROBINS-I Hirst, 2009 Qualitative Questionnaires JBI Khot, 2022 Qualitative Questionnaires JBI Kildea, 2006 Qualitative Questionnaires JBI Kogutt, 2019 Qualitative After Action Reporting JBI Kumar, 2018 Qualitative Questionnaires JBI Kumar, 2019 Qualitative Surveys JBI Kumar, 2021 Qualitative Interviews JBI Li, 2024 Quantitative Confidence Scores ROBINS-I Lutgendorf, 2017 Quantitative Comfort Levels ROBINS-I Madden, 2011 Qualitative Reported Observations JBI Malhotra, 2021 Unsure/Mixed Preliminary Observations JBI Meeker, 2018 Qualitative Questionnaires JBI Miller, 2008 Qualitative Questionnaires JBI Miller 2023 Quantitative Pre and post knowledge quiz, % Evidence Based Practices performed ROBINS-I Monod, 2014 Qualitative Questionnaires JBI Pak, 2015 Qualitative Debriefing sessions JBI Pauley, 2016 Qualitative Questionnaires JBI Prasad, 2020 Qualitative Researcher observations of recordings JBI Prasad, 2022 Qualitative Thematic analysis of questionnaires JBI Rosenberg, 2021 Quantitative Assessment quiz pre and post ROBINS-I Shaw-Battista, 2015 Qualitative Questionnaires JBI Stieglitz 2023 Quantitative Performance assessment post simulation ROBINS-I van der Scheer, 2023 Quantitative Confidence Scores, Feedback ROBINS-I Varghese, 2016 Quantitative Assessment quiz pre and post ROBINS-I Walker, 2014 Unsure/Mixed 1. pre/post assessment 2. questionnaire 3. assessor scores JBI Walker, 2015 Quantitative Pre and post questionnaires: knowledge via quiz (quant) and self-efficacy scores (qual) ROBINS-I Walker, 2016 Quantitative perinatal mortality at 12-month & death rate from obstetric haemorrhage ROBINS-I Walton, 2016 Quantitative Birth observations - ebps ROBINS-I Wu, 2024 Unsure/Mixed Clinical Teamwork Scale (CTS) ROBINS-I Zech, 2017 Qualitative questionnaires JBI Zhong, 2021 Unsure/Mixed Free Text Surveys JBI Bias due to confounding 11 studies demonstrated a low level of confounding and 5 studies indicated a moderate level of confounding. Confounding tended to be a result of access to resources, differences in facility staffing, underlying illness, baseline rate of complications, prior clinical exposure and training. Selection bias 14 out of the 16 studies had a low level of selection bias. Selection bias was most prominent in Greer (2023), where only about 50% of workshop participants went on to study enrolment afterward. There was also an unequal distribution of participants between specialties in this study, with lower rates of participation from paediatrics and anaesthesia, with the study itself reporting that selection biases could have affected the knowledge results ( 23 ). Bias in the classification of intervention There was a low level of bias across all the included studies assessed by the ROBINS-1 tool in this category. Bias in deviations from the intended interventions 13 of the 16 studies exhibited a low level of bias in deviations from the intended intervention. Of note, in Stieglitz (2023), participants completed varying amounts of the e-learning module prior to participating in the simulation session, revealing a serious deviation from the intended intervention ( 45 ). Bias due to missing data 3 of the 16 studies had significant data gaps which contributed to a serious risk of bias in this category. Additionally, 3 other studies had moderate risk of bias due to missing data, with the remainder of the studies data being largely complete. For example, in Dettinger (2018), of the 182 participants, only 165 completed the first training module and only 148 completed the second training module ( 19 ). In Gomez (2018), only 50% of participants were assessed at the 1-year mark, leading to significant missing data in assessing the second aim of this study which was retention of knowledge ( 22 ). Bias in the measurement of outcomes Bias in the measurement of outcomes was the subcategory that was most significant when considering the included studies. 13 of the 16 studies had a moderate level of outcome measurement bias and 2 had serious risk of bias ( 23 , 31 ). Only 1 study had a low risk of bias ( 52 ). Some examples of bias in the measurement of outcomes included lack of blinding, subjectivity due to self-reporting of outcome measures, an incomplete dataset and outcome assessors being aware of the intervention provided. Bias of the selection of reported result There was a low of level of reporting bias in 15 of the 16 studies. In Ellard (2016) there was incomplete outcome data on one of the primary outcomes leading to a moderate level of bias in the selection of the reported result ( 21 ). DISCUSSION In the context of high global neonatal and maternal mortality, this systematic review of 40 studies evaluated the current literature on IP SBT in obstetric and neonatal emergencies, with a focus on the prevalence and effectiveness of IP SBT in these fields. They key outcomes focused on the role of the simulation environment, participant self-reported learnings and impacts at an organisational and hospital level. The simulation environment was seen by participants as safe, supported and realistic. IP SBT improved practitioner teamwork and communication skills whilst highlighting gaps in knowledge and skills. At an organisational level, IP SBT led to identification of equipment and protocol gaps. We also reviewed limitations of IP SBT training and looked to possible future directions of research. A key outcome of this systematic review was the integral role that SBT plays in developing IP team skills and behaviours in acute obstetric and neonatal emergencies. Whilst we could not establish causality, it appears that the improvement in team skills is present in both high and low-income settings and with low and high-fidelity simulation equipment. Several studies in other areas of healthcare outside of obstetrics and neonatology corroborate this, having shown that SBE training has contributed to teamwork and communication development in other fields. An example of this is a recent systematic review and meta-analysis of randomised control trials (RCTs) by Sezgin and Bektas in 2023 evaluating the effectiveness of SBT programs amongst healthcare students. The meta-analysis in this paper showed a statistically significant improvement in teamwork and communication skills through IP SBT training (p < 0.001) ( 55 ). Similarly, In Greer (2023) it is notable that in the post-hoc analysis which corrected for comparators showed that Clinical Teamwork Scale (CTS) scores increased significantly from pre-intervention to post-intervention in all categories except the ”other/patient friendly” category (p < 0.001) ( 23 ). Kiessling (2022) showed a statistically significant improvement in overall participant confidence (p < 0.0001) in an IP team environment as a result of SBT in emergency medicine, with the these improvements lasting over a 6-month period ( 56 ). In Bhatia (2023), when referring to situation awareness and skill development in SBT, one participant said: “... As I got to know and practice how to coordinate a team, [I learned that] we can't manage alone [in] such emergencies…” ( 18 ) A participant in Khot (2022) suggests that: “An interprofessional workshop like this helps us know the importance of each team member irrespective of qualification,” ( 25 ) and that “This i.e. interprofessional learning was the best part of the workshop.” ( 25 ) Studies like Pauley (2016) that included participants other than midwifery and medical staff as part of the IP team also had a positive experience. A midwife in this study said it was: “‘Really helpful to have paramedics present to help understand how we work alongside each other in emergencies. As a newly qualified midwife, good to prompt me to think about managing emergencies in community.” ( 40 ) Teamwork also contributed to the preparation process for emergencies. In Varghese (2016) drill training prompted staff to work together to prepare emergency trays for PPH. One participant said: “Prior to the training we were not aware of effective teamwork…some of us would have forgotten a few things, but yesterday [during PPH case management drills] as it was teamwork, even if one of us forgot something, others would remind them about those things.” ( 47 ). Leadership was reflected on by Madden (2011) who suggested that a single leader is insufficient to provide the best possible clinical outcomes in an emergency situation and each health professional is responsible to work effectively within the team ( 33 ). Finally, in Walton (2016) we can see that the PRONTO training program overall had a positive impact in Guatemala, with SBA’s at intervention sites providing more patient-centred care, use more evidence-based medicine, and implementing more communication and teamwork tools compared to the participants in the control sites ( 51 ). Development of communication skills through IP SBT was another key outcome. In Afulani (2020) participants noted the importance of an IP team in facilitating good communication and vocalising, thereby preventing medical errors. One participant said: “It was great because especially like the think out loud...maybe if you are working with your colleague, and you have something and are doing it to the patient, if you say it out loud your colleague will know what you are doing or what you are thinking. Because you may be thinking that what you think is the correct thing while you are doing the wrong thing.” ( 16 ). In Meeker (2018), there was a statistically significant improvement in both teamwork (p = 0.041) and communication (p = 0.031) following high fidelity IP SBT ( 35 ). In Miller (2023), use of certain communication strategies in IP SBT in Kenya and Uganda saw a 16.8% increase in participants performing actions like calling for help and thinking out loud, both techniques that were used in over 90% of the simulations ( 37 ). Pak (2015) identified significant gaps in communication which led to confusion, doubling up of tasks and delays which subsequently led to the implementation of ‘corrective actions’ ( 39 ). For example: Epinephrine was ordered by an ED resident but the order was not directed to a specific nurse. Two nurses stepped away to draw up the medication, with no verbalization by either nurse as to who would carry out the order. Time was wasted when the ED physician clarified whether the medication had been administered, and the two nurses had to sort out what was done for the patient. ( 39 ) Online learning was perceived by some as a barrier to effective communication, and helpful by others. In Prasad (2022), one participant said: “It feels more awkward to participate on zoom and communication can sometimes be hampered.” ( 41 ) However, other participants in the same study reflected that online IP SBT: ““…was good at showing us how midwives, obstetricians, junior trainees and paediatricians all work together and have designated jobs and how they communicate most effectively!” ( 41 ) “By attending the zoom, I have had an opportunity to observe the communication and roles among different health professionals, which could be quite hard when attending in person.” ( 41 ) Another important outcome identified in this review, was the role of IP SBT in improving patient and healthcare outcomes. For example, in Ellard (2014), one participant noted that: “We used to have a lot of neonatal deaths because of poor skill of resuscitation before ETATMBA, because easily giving up...We’ve actually seen that the babies that we then used to say no…have survived, actually very healthy babies.” ( 20 ) Ellard (2014) additionally noted the importance of knowledge and skill acquisition in an IP team setting to improve patient outcomes, alongside its role in building confidence: “…we are really following the partogram and we are really taking action on each and every deviation from the normal. Not only ETATMBA students but even the nurses. So, we are working together now.” ( 20 ) “I applied the B-lynch suture, with my colleague another ETATMBA trainee...we applied it and the patient actually, stopped bleeding. The patient actually went home…was discharged from the facility...it gave me courage…” ( 20 ) In Gomez (2018) there was a significant reduction in newborn mortality from one month to the next over the one year long low dose high frequency training (LDHF) intervention period, alongside a drop in the rate of stillbirths ( 22 ). Moreover, Lutgendorf (2017) observed that through running IP SBT it became apparent there were ‘system improvements’ that needed to occur at a hospital level that could prevent negative impacts on patient health outcomes ( 32 ). For example, during one of IP SBT exercises, it was identified that tranexamic acid and colloid resuscitation fluids were not readily available in their usual location on the ward. Due to this drill, these problems were rectified prior to a ‘near miss’ or a negative patient outcome occurring ( 32 ). Miller (2008) through IP SBT identified several ‘teamwork failures’ that were subsequently addressed. These included a lack of situational awareness, closed-loop communication, use of standardised communication measures, a shared mental model, protocol adherence and process issues between departments ( 36 ).. In Miller (2023) there was a notable improvement in the knowledge and practice of sepsis management and a 34% decrease in stillbirth and neonatal mortality together when comparing intervention and control facilities ( 37 ). Rosenberg (2021) affirmed similar positive findings in their Rwandan IP SBT workshops, where a paired t test comparing pre-workshop and post-workshop knowledge scores showed a statistically significant increase following the EONC1 and EONC 2 training programs (P < 0.0001) ( 43 ). Thus, it is evident that the implementation of IP SBT contributes to improved patient and healthcare outcomes through knowledge development, team skills and system improvements. LIMITATIONS Across the 40 included studies there were several limitations. To begin, a meta-analysis was not performed due to significant data gaps and lack of quantitative data related to clinical patient outcomes across the studies. Additionally, tools assessing qualitative outcomes in IP SBT were of a variety, and more common tools (e.g. Likert scores) were not used consistently across all the included studies. Limitations such as this made it challenging to draw comparisons between various IP SBT programs. Another limitation was the significant variability between simulation programs provided across the studies, with regards to the simulation fidelity, structure, modality and facilitators. Whilst many studies suggested high fidelity simulation training was more efficacious, Kumar (2019) showed that low-cost simulation devices, such as mobile simulators, were also successful in providing cost-effective training to countries with fewer resources ( 29 ). Varghese (2016) reported that there was an inadequate monitoring system for feedback ( 47 ). A limitation to online learning identified by Prasad (2022) was that of learners being unable to practice procedural skills ( 41 ). The quality of trainers also varied significantly, including experienced obstetricians and neonatologists who were key members of ONE-Sim workshops in Bhatia (2023) ( 18 ) to individuals who had been trained as peer practice coordinators (PPCs) to lead simulations sessions in Gomez (2018) ( 22 ). Accounting for the above factors, the quality of education provision in the simulation setting needs to be further assessed with a goal towards standardisation, as it will likely impact both qualitative and quantitative outcomes. There were additional limitations with selection, outcome and reporting bias. For example, Zech (2017) had a small sample size which contributed to selection bias ( 53 ). There was an imbalance of the various practitioners within the interdisciplinary teams in Meeker (2018) ( 35 ). Walton (2016) suggested that those who participated in PRONTO training may have been more motivated to practice their learnt skills than those who didn’t, contributing to bias in outcome assessment ( 51 ). Variations in knowledge gains secondary to IP SBT training were noted, where in Greer (2023) obstetric participants had significant increases in their knowledge following training, whilst knowledge scores were similar from pre-training to post-training for other specialties like family medicine, nursing, anaesthesia and paediatrics ( 23 ). This could be related to several factors including that the workshops were targeted towards the skill set and knowledge base of one specialty or that there was a variation in practitioner presence and interest across the different specialities. Many studies also had loss to follow up leading to attrition bias ( 35 , 37 , 38 ). Reporting bias was also noted. For example, in Ellard (2014) there was some concern that participants would only report and feedback what they thought was considered ‘socially acceptable’ to the team ( 20 ). Finally, provision of minimal SBT sessions and short term follow up raises limitations in the maintenance of learnt skills and their translatability to clinical practice. Most of the included studies only measured learnings immediately after training and in a simulated context. This short duration of programs, lack of sustainability or evidence of transability to real life clinical practice and lack of opportunity for ongoing education were all future areas of change indicated by many studies. In Afulani (2020), one participant said: “…it is difficult for one person to implement change, but if a lot of people buy into the idea or get the knowledge, it is easier to do it. Because if I am there and I do it for shift, and I am going, and no other person can continue to do it, the purpose [of the training] will be defeated. But if other people get to know and have the skill then whatever you need from them they will continue, and you will have the continuity of care which is good for the patient.” ( 16 ) Some studies also suggested that more analysis is required to see if the program provided is relevant to the needs of the area and supported the idea of local facilitators being taught to run IP SBT sessions. For example, Hirst (2009) ensured that the learnings provided by the SCORPIO workshop were both relevant to the local Vietnamese province and were provided in a culturally sensitive manner, and they achieved this by carefully assessing the community’s needs and liaising with local health professionals ( 24 ). In Kildea (2006), 85 practitioners in a remote setting completed to a ‘needs assessment’, the responses to which then helped determine the content and delivery for the MEC IP SBT program in rural Australia ( 26 ). Finally, a few studies questioned whether learning in simulation translated to clinical practice and actually improved clinical outcomes ( 18 , 23 , 24 , 26 , 28 – 31 , 36 , 49 , 50 , 52 , 54 ) whilst others suggested that IP SBT is translatable into real life clinical practice ( 16 , 19 , 20 , 22 , 32 , 43 , 51 ). This was an outcome measure that was not consistently assessed across the included studies. Ultimately, more research and implementation of IP SBT training globally is required to increase knowledge, awareness and outcomes for practitioners and patients. While IP SBT is becoming more widely taught, there are gaps in the literature regarding efficacy, type of workshop, individualised training, benefits of local trainers, translatability to real life practice and cost effectiveness of such training programs globally, especially in obstetrics and neonatology. Together, these limitations suggest the need for further studies in this area with repeated IP SBT workshops, quantitative outcome assessment and longer follow-up periods. FUTURE DIRECTIONS Online vs face to face IP SBT Standardisation of obstetric and neonatal emergency IP SBT provided globally needs to occur, and this could be achieved through online training. Online simulation training has shown improvements in practitioner outcomes ( 25 , 28 – 30 , 34 , 41 , 42 ). Stieglitz (2023) suggests that blended learning should be increasingly used to safely manage emergencies that rarely occur in clinical practice ( 45 ). For example, in this study, participants were first provided approximately an hour of theoretical e-learning on shoulder dystocia. This was followed by the face-to-face component of this SBT program where the previously learned knowledge was applied on a birth stimulator in a shoulder dystocia simulation ( 45 ). Moving forward, as Anderson (2005) suggests, it would be beneficial to conduct research that evaluates a range of training methods ( 17 ) to better understand the efficacy of SBT, both face to face and online. Video based learning In some studies, such as Greer (2023), simulation sessions were recorded using GoPro cameras. These recordings were then used kept as backup and reviewed if < 80% of the required items were assessed during the live simulation itself ( 23 ). It appears that video recordings have the potential to enable practitioners and facilitators to re-review simulation performance and may provide a better analysis of gaps and assist with the debrief process. Further studies need to be undertaken to analyse this whilst being cognisant of and ascertaining any relevant issues with related to consent and privacy. Training local stakeholders to facilitate SBT provision Rosenberg (2021) suggests that interventions that are focused on local stakeholders are likely to have greater uptake and be more successful ( 43 ). Khot (2022) suggests a model where the ‘learner becomes the educator’ ( 25 ). In this systematic review, studies that included courses taught by local stakeholders (e.g. the EONC course in Rwanda in Rosenberg (2021)) allowed for strengthened IP connection within and outside the hospital ( 43 ). Here, creating a group of local teachers meant that in the future further training sessions can be conducted across the country and other countries within that region if feasible ( 43 ). Ellard (2014, 2016) suggest that training more NPCs in areas of healthcare workforce shortages, where feasible from a resource perspective, ( 20 , 21 ) is likely to significantly improve care provision in areas with limited physician and midwifery staffing ( 26 ). Ongoing training to aid translation into practice A common theme that emerged across the included studies was participants’ desire for additional training sessions and the inclusion of more practitioners within the SBT sessions ( 16 ), suggesting that this would lead to an improvement in long term outcomes ( 29 ). Future SBT provision should aim to review whether sustained IP SBT training across multiple sessions and sites further improves practitioner and patient outcomes in the longer term. Standardisation, feasibility and cost effectiveness analysis This review has revealed that whilst several benefits exist in the provision of IP SBT, there needs to be further consideration from a feasibility, cost effectiveness, practicality and clinical outcomes perspective. Global standardisation of IP SBT is likely to be difficult to achieve in the context of different types of practitioners, varying skillsets, resource availability and funding limitations. Our systematic review suggests that SBT is emerging in its prevalence globally with efficacies in practitioner, organisational and clinical outcomes. Future work could aim to review the cost effectiveness of including IP SBT programs in different countries as a standardised component of clinical obstetric and neonatal training and practice for healthcare staff. CONCLUSIONS This review systematically evaluated the available evidence for IP SBT and the impact of its implementation on obstetric and neonatal care outcomes across the globe. In both qualitative and quantitative studies, this review has demonstrated that the use of SBT programmes has led to improvements at clinician, patient and organisational levels. Broader scale implementation of IP SBT programs across the globe in obstetrics and neonatology is necessary and is likely to translate into higher quality care as well as improved practitioner and patient outcomes. Abbreviations ED, emergency department; EONC, Emergency Obstetrics and Neonatal Course; ETATMBA, Enhancing Training And Technology for Mothers and Babies in Africa; GRADE, Grading of Recommendations Assessment, Development and Evaluation; IP, interprofessional; JBI, Joanna Briggs Institute; PPE, personal protective equipment; PPH, post-partum haemorrhage; PRONTO, Simulation and Team Training for Obstetric and Neonatal Emergencies; ROBINS, Risk Of Bias In Non-randomised Studies-of Interventions; SBE, simulation-based education; SBT, simulation-based training. Declarations Contributions of the authors: M.B.: conception and design, data collection and assembly, data interpretation and analysis, risk of bias assessment, manuscript writing and editing. K.Z.: literature searching, data collection and assembly, risk of bias assessment, manuscript writing. J.S.: data collection and assembly, risk of bias assessment, manuscript writing. E.P.: manuscript editing, supervision. A.K.: conception, manuscript editing. A.M.: conception and design, manuscript editing, supervision. Funding: Funding was received by A.M. from the National Health Medical Research Council, Australia (NHMRC). The NHMRC was not involved in data collection, analysis or creation of this systematic review. Conflicts of interest: There are no conflicts of interest that we are aware of. Author Contribution M.B.: conception and design, data collection and assembly, data interpretation and analysis, risk of bias assessment, manuscript writing and editing. K.Z.: literature searching, data collection and assembly, risk of bias assessment, manuscript writing. J.S.: data collection and assembly, risk of bias assessment, manuscript writing. E.P.: manuscript editing, supervision. A.K.: conception, manuscript editing. A.M.: conception and design, manuscript editing, supervision. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6344547\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":449736488,\"identity\":\"70bcb52c-a8ee-4f83-bf90-5566b4a90210\",\"order_by\":0,\"name\":\"Manini Bhatia\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Manini\",\"middleName\":\"\",\"lastName\":\"Bhatia\",\"suffix\":\"\"},{\"id\":449736489,\"identity\":\"f13a7625-5095-4060-a95d-6f02a640c6c1\",\"order_by\":1,\"name\":\"Kelly Zhou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kelly\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"},{\"id\":449736495,\"identity\":\"e46e8d04-0f92-46ef-8593-fd81a0fbdc78\",\"order_by\":2,\"name\":\"Jainil Shah\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jainil\",\"middleName\":\"\",\"lastName\":\"Shah\",\"suffix\":\"\"},{\"id\":449736496,\"identity\":\"d2a1a1e5-fe51-4d03-b32a-d132e161d8a4\",\"order_by\":3,\"name\":\"Elisha Purcell\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Elisha\",\"middleName\":\"\",\"lastName\":\"Purcell\",\"suffix\":\"\"},{\"id\":449736497,\"identity\":\"671f57a7-e457-496a-9bba-647075200f58\",\"order_by\":4,\"name\":\"Arunaz Kumar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Arunaz\",\"middleName\":\"\",\"lastName\":\"Kumar\",\"suffix\":\"\"},{\"id\":449736498,\"identity\":\"8b99a6a0-db1f-4428-bb17-c29dcec434c2\",\"order_by\":5,\"name\":\"Atul Malhotra\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYHACxgNAQsYAzK4Ak2xAzIxbA1AapIXHAKzoDMlaGNuI0MI/v8fgAGOOHY85e/+xDz/nbZMzZz/+7AFDhXViAw4tEsd4gFq2JfNY9hxmntm77baxZU+OuQHDmXScWhggWph5DG4kMzPwbruduOFADpsEY9thnFrkIVrqwVoY/84Bajn//JkE4z/cWgwgWg6DtTDzNgC13Egwk2BswK3F8FhawYHEbcd5DM4cNmaWOXbb2ODGGzOJhGPpxri0yB0+vPHBx23VcgbHGx8zvqm5LWdwPv2ZxIcaa1mc3geBBCJERsEoGAWjYBSQAgCekVtaEAW+LQAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Monash University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Atul\",\"middleName\":\"\",\"lastName\":\"Malhotra\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-03-31 11:53:29\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6344547/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6344547/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":82163865,\"identity\":\"16886744-81c6-4dae-8874-5543d05a3e71\",\"added_by\":\"auto\",\"created_at\":\"2025-05-07 08:57:09\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":288130,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePRISMA flow chart outlining the study selection process extracted from Covidence (Line 209, page 8)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6344547/v1/23e7b4b45d9db3a7d7a4d4f8.jpg\"},{\"id\":82162023,\"identity\":\"1a10796f-e07a-42d1-badf-cd2dfac8030b\",\"added_by\":\"auto\",\"created_at\":\"2025-05-07 08:41:08\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":88777,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eGlobal distribution of interprofessional SBT programs (Line 242, page 9)\\u003c/p\\u003e\\n\\u003cp\\u003eImage Credit: https://en.m.wikipedia.org/wiki/File:BlankMap-World-v7.png (\\u003cu\\u003e57\\u003c/u\\u003e)\\u003c/p\\u003e\\n\\u003cp\\u003eChanges were made to the original file by overlaying shapes and text to indicate countries where SBT training programs took place. This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license (https://creativecommons.org/licenses/by-sa/3.0/deed.en)\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 2 Legend\\u003cbr\\u003e\\n1. Size of circle - Number of programs conducted in specified country\\u003c/p\\u003e\\n\\u003cp\\u003e2. Colours within the circles - Type of programs run conducted in specified country\\u003c/p\\u003e\\n\\u003cp\\u003e3. Pie chart slices - Proportion of each program conducted within specified country\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6344547/v1/b16fa54804ba158e5f8e7aac.jpg\"},{\"id\":82162022,\"identity\":\"e98b56bc-aaeb-4f4f-9102-f8c2fca4fd70\",\"added_by\":\"auto\",\"created_at\":\"2025-05-07 08:41:08\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":84387,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eApplication of ROBINS-1 tool for risk of bias assessment for quantitative Studies\\u003c/p\\u003e\\n\\u003cp\\u003e(Line 380, page 14)\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6344547/v1/9b560b983e317390ebb5d85a.jpg\"},{\"id\":88999621,\"identity\":\"0a7d874d-b60f-4e58-8f70-3c975fdb1397\",\"added_by\":\"auto\",\"created_at\":\"2025-08-13 15:09:02\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1925794,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6344547/v1/6e124237-87b9-442f-ac6e-3a7c20468996.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Interprofessional Simulation Based Training for Obstetric and Neonatal Emergencies: A Systematic Review\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eSimulation is becoming a key part of training of healthcare professionals who are involved in managing both obstetric and neonatal emergencies across the globe. In clinical practice, such emergencies are often attended to by multidisciplinary teams, which include doctors, midwives, nurses, students and other observers or helpers. We need appropriately trained clinicians to be available and prepared to provide effective emergency care with skill and confidence. Moreover, it is widely acknowledged that poor IP teamwork and communication during obstetric emergencies are some of the biggest contributors to maternal death (\\u003cspan additionalcitationids=\\\"CR2 CR3 CR4\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). The effectiveness of SBT programs in team-based interventions has already been established in a large number of non-medical fields including aviation, military and education (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR7\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e). Rakshasbhuvankar (2014) showed that SBT improves resuscitation scores and decreases the time it takes to achieve resuscitation steps, likely resulting in safer care and preventing risk (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Managing obstetric and neonatal emergencies in an integrated manner often requires simultaneous resuscitation of both the mother and the newborn, highlighting the need for comprehensive global IP SBT programs.\\u003c/p\\u003e \\u003cp\\u003eHowever, most current SBT programs are unfortunately limited by their focus on teamwork within a single profession or on specific types of emergencies. This is usually either obstetric or neonatal care alone, rather than together. This is a significantly limited approach because it does not support the nuanced management of complex real-life emergency situations which require cohesive responses from several interdisciplinary professionals. The World Health Organization (WHO) defines interprofessional education (IPE) as education that happens when \\u0026lsquo;students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes\\u0026rsquo; (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThis systematic review is the first to assess how providing IP SBT can impact on the management of obstetric and neonatal emergencies worldwide. Our team provides a review on the prevalence and effectiveness of IP SBT by analysing outcomes of practitioners, patients and health services using both qualitative and quantitative tools. Through conducting this review, we hope to enhance availability, simulation design and implementation of IP SBT on a global scale.\\u003c/p\\u003e\"},{\"header\":\"METHODS\",\"content\":\"\\u003cp\\u003eThe aim of this review was to investigate the prevalence and effectiveness of IP SBT in managing combined obstetric and neonatal emergencies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e) were followed when preparing and compiling this review. We registered our protocol on PROSPERO prospectively (CRD42024591980).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003cspan type=\\\"SmallCaps\\\" class=\\\"SmallCaps\\\" name=\\\"Emphasis\\\"\\u003eCRITERIA FOR SELECTION\\u003c/span\\u003e\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eStudy types\\u003c/h2\\u003e \\u003cp\\u003e We considered all publications and study designs to be eligible for this review. Only studies where the full text was available in English were included. Certain types of research and publications such as literature reviews, discussion pieces, conference abstracts, editorials and protocols were not included in our systematic review.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eParticipants\\u003c/h3\\u003e\\n\\u003cp\\u003eIP SBT was defined in our review as training that involved healthcare workers from at least two of the following disciplines: medical, nursing, midwifery, or other relevant areas and we ensured that our included studies investigated IP SBT in this context. An exception to this definition was made for health care facilities across the globe that were staffed solely by skilled birth attendants (SBAs).\\u003c/p\\u003e\\n\\u003ch3\\u003eSimulation/intervention types\\u003c/h3\\u003e\\n\\u003cp\\u003eIncluded studies were required to focus on both obstetric and neonatal emergencies, which we defined as emergencies related to labour and the birthing process. For example, simulation of post-partum haemorrhage (PPH) was included, while management of antenatal conditions like gestational diabetes was not. Inclusion and exclusion criteria are documented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eInclusion and Exclusion Criteria\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInclusion Criteria\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExclusion Criteria\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e● Studies that focus on obstetric and neonatal emergencies\\u003c/p\\u003e \\u003cp\\u003e● Must involve interprofessional simulation-based training\\u003c/p\\u003e \\u003cp\\u003e● Full article accessible in English\\u003c/p\\u003e \\u003cp\\u003e● Available electronically\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e● Literature reviews, discussion pieces, conference abstracts, editorials, protocols\\u003c/p\\u003e \\u003cp\\u003e● Antenatal emergencies\\u003c/p\\u003e \\u003cp\\u003e● Neonatal emergencies outside of the birthing process\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eOutcomes\\u003c/h3\\u003e\\n\\u003cp\\u003eOutcomes related to the simulation environment, clinician self-reported outcomes, participant outcomes and organisational outcomes were accepted and reported on.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003cspan type=\\\"SmallCaps\\\" class=\\\"SmallCaps\\\" name=\\\"Emphasis\\\"\\u003eSYSTEMATIC SEARCH\\u003c/span\\u003e\\u003c/h2\\u003e \\u003cp\\u003eA systematic database search was conducted of articles that explored the use of obstetric and neonatal IP SBT in PubMed, EMBASE, CINAHL and MEDLINE from inception to March 2023 by author KZ initially. To be sure of relevancy and recency of our search and that newer studies were also included, we repeated the search strategy again in October 2024 (KZ), closer to the completion date of our systematic review. We did not filter for language or publication date in both the searches. Our search strategy is outlined in detail below in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSearch Strategy\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDatabases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSearch Strings\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDate performed\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePubMed\\u003c/p\\u003e \\u003cp\\u003eEMBASE\\u003c/p\\u003e \\u003cp\\u003eCINAHL\\u003c/p\\u003e \\u003cp\\u003eMEDLINE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e((((doc* OR nurs* OR midwi* OR student) AND (team* OR interprofessional OR interdisciplinary OR multidisciplinary)) AND (obste* OR birth OR delivery OR labor OR newborn OR neonat*)) AND (emergenc* OR crisis OR resus*)) AND (simulat* OR train* OR drill OR educat*)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMarch 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOctober 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eSTUDY CHOICE AND DATA COLLECTION PROCESS\\u003c/h3\\u003e\\n\\u003cp\\u003e We used the Covidence Systematic Review Software to assist us with the study selection process. Covidence is a systematic review management platform that is operated by Veritas Health Innovation Ltd in Melbourne, Victoria, Australia. The compiled studies from the various databases were exported into the Covidence software with automatic removal of duplicated files. A manual deduplication was then subsequently repeated by authors JS and KZ to make sure all the duplicated studies had been appropriately removed. JS and KZ then individually screened the titles and abstracts and removed any studies that did not meet the inclusion criteria. Several studies were also considered ineligible in this process based on our exclusion criteria. JS and KZ then independently reviewed and performed full-text screening on the remaining studies to analyse in more detail if they met our inclusion criteria. Third reviewer MB resolved conflicts for any studies where JS and KZ had a differing opinion on whether the study met the selection criteria. This process resulted in a total of 40 included studies. JS and KZ then individually took the relevant data from these studies and placed it into a table in a Microsoft Excel spreadsheet. Our team followed the usual data extraction process that is suggested by \\u003cem\\u003eThe Cochrane Handbook\\u003c/em\\u003e (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eRISK OF BIAS AND CERTAINTY OF EVIDENCE\\u003c/h3\\u003e\\n\\u003cp\\u003eThe ROBINS-I tool was used to assess risk of bias in quantitative studies (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e) and the JBI critical appraisal tool was used to assess risk of bias in qualitative studies (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e)., Two review authors (JS, KZ) individually performed the risk of bias assessment for each study and any conflicts were resolved by third review author (MB). We chose the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to review the certainty of evidence (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e).\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eA PRISMA flow diagram (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) obtained from Covidence summarises our selection process for studies as described above.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe initial database search provided 6374 studies which were exported into Covidence. 1840 studies were excluded by removing duplicates, leaving 4534 studies. Of these, 4278 studies were removed in the title and abstract screening stage. This left 256 studies for which full papers available in English were obtained. JS and KZ independently performed full text screening on these 256 articles, and MB (a third reviewer) resolved any conflicts. After further excluding another 216 studies, this left a total of 40 studies for the final data extraction. (\\u003cspan additionalcitationids=\\\"CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31 CR32 CR33 CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48 CR49 CR50 CR51 CR52 CR53\\\" citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e). Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e summarises important aspects of these selected studies including (but not limited to) SBT duration, content, country, disciplines involved, and main reported outcomes.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSummary of included studies Place in text: Line 218, page 9\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"13\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eAbbreviation\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eFull title\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eAssociate clinician\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAHW\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eAllied Health Workers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eAROM\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eAcute rupture of membranes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBCU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eBiocontainment Unit\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eBLS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eBasic Life Support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eConfidence interval\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCORE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eCombined Obstetrics Resuscitation and Emergencies Training Project\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eCaesarean section\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eCTS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eClinical teamwork scale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eHPS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eHigh-fidelity human patient simulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eIFH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eImpacted foetal head\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eLDHF\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eLow Dose High Frequency\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eMCA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eMaternity Care Assistant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eMEC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eMaternity emergency course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNKLM\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eNational Competence Based Learning Objectives Catalogue for Medicine\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNICU\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eNeonatal intensive care unit\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eNPC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eNon physician clinician\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eOB-STaT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eObstetrics Simulation Training and Teamwork\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eO\\u0026amp;G\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eObstetrics and Gynaecology\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eONE-Sim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eObstetrics and Neonatal Emergency Simulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eOSCE\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eObjective Structured Clinical Exam\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePROMPT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003ePractical Obstetric Multi-Professional Training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eRAN\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eRemote Area Nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eRN\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eRegistered Nurse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSBA\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSkilled birth attendant\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSCN\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eSpecial Care Nursery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSCORPIO\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eStructured, Clinical, Objective Referenced, Problem-oriented, Integrated, and Organized\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eSTT\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c10\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eSimulation and Team Training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c13\\\" namest=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFirst author, year\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePopulation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSize\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDisciplines Involved\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSimulation Training Program\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEmergency Scenarios Simulated\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eStudy Objective\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eTraining Structure/Duration\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eMeasure(s) of\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003eEffect\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipant Outcome(s)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eClinical Outcome(s)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdams et al, 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical residents, nursing students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003e-\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, Pre/Eclampsia, Neonatal Resuscitation, Perimortem CS, Shoulder Dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eDemonstrate feasibility of clinical training program\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5 x 15 mins simulations (and 10 min debrief each)\\u003c/p\\u003e \\u003cp\\u003e1 Skills Station\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training survey\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e\\u0026minus;\\u0026thinsp;92.9% reported training as useful\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfulani et al, 2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eGhana\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, doctors, nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eRespectful Maternity Care (modified PRONTO)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5 Scenarios from: PPH, antepartum haemorrhage, intrapartum haemorrhage, neonatal resuscitation, shoulder dystocia, cord prolapse, breech, pre-eclampsia/eclampsia, sepsis, preterm labour/birth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eDetermine effectiveness of program on provider knowledge and self-efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-Training Survey, Knowledge Tests and Interviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Increased knowledge and self-efficacy scores (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003cp\\u003e- 95% participants reported training as useful\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnderson et al, 2005\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUK\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e228\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, obstetricians, paediatricians, anaesthetists, theatre staff, health care assistants\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eFire drills, classroom-based emergency training sessions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eMassive obstetric haemorrhage, shoulder dystocia, eclampsia, maternal and neonatal resuscitation, cord prolapse, breech delivery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eA postal survey to ascertain whether labour wards in England and\\u003c/p\\u003e \\u003cp\\u003eWales are conducting drills, and if so, how they are\\u003c/p\\u003e \\u003cp\\u003eorganised and evaluated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eFortnightly, monthly or 3\\u0026ndash;4 times a year.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePostal questionnaire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Of the 185 units that were interviewed, 95 centres (51%) were conducting \\u0026lsquo;fire drills\\u0026rsquo;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBhatia et al, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical and Nursing Students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNormal and obstructed labour, shoulder dystocia, PPH, neonatal resuscitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo analyse undergraduate medical/nursing students\\u0026rsquo; situational awareness during ONE-Sim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3-3.5 hours course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre and post training surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported improved environmental perception, protocol and situation specific knowledge, prioritisation and teamwork skills\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDettinger et al, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eKenya\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e182\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical officers, clinical officers, nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNormal birth, uterine atony, placenta praevia, cervical laceration, incomplete abortion, neonatal resuscitation, shoulder dystocia with severe PPH, preeclampsia, eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eMeasure impact of PRONTO training on knowledge, self-efficacy and teamwork self-assessment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3-day program\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre and post training knowledge tests, self-efficacy and teamwork surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Improvements in knowledge, self-efficacy and teamwork (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEllard et al, 2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eMalawi\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNPCS/ACS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eETATMBA Project - Malawi\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eExternal cephalic version, vaginal breech, PPH, B lynch suture, shoulder dystocia, eclampsia, vacuum extraction, obstructed labour\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eEvaluate implementation of ETATMBA and changes to practice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e6 modules across 30 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003epost-module interviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Trainees reported cascading of knowledge onto peers, implementation of new knowledge and skills, and confidence in initiating changes in practice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEllard et al, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eTanzania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNPCS/ACS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eETATMBA Project - Tanzania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNot Specified\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eExplore impact of ETATMBA on maternal/neonatal health outcomes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e16-week training program\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eExamination of pre/post-intervention maternal/neonatal health indicators, survey of health facilities in rural Tanzania\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e- Non-significant downward trend in maternal deaths over 2 years\\u003c/p\\u003e \\u003cp\\u003e- No significant differences in maternal/neonatal/birth complication variables across time points\\u003c/p\\u003e \\u003cp\\u003e- Surveys revealed shortages in key areas (e.g. availability of running water, ambulances)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGomez et al, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eGhana\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e403\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eSBAs (registered/certified Midwives)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eLDHF Training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation, pre-Eclampsia/eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo assess the effect of LDHF training approach on long-term evidence-based skill retention amongst skilled birth attendants and impact on adverse birth outcomes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2 x 4-day sessions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eRelative risks of institutional intrapartum stillbirths and 24h newborn mortality in months 1\\u0026ndash;6, 7\\u0026ndash;12 (compared to historical cohort period), Pre/Post Intervention Knowledge Tests\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- After 1 year, 200 SBAs assessed had 28% (95% CI 25\\u0026ndash;32; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0\\u0026middot;001) and 31% (95% CI 27\\u0026ndash;36; p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0\\u0026middot;001) higher scores than baseline on low-dose 1 and 2 content skills, respectively\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e- Sustained decrease in facility-based 24h newborn mortality and intrapartum stillbirth (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0\\u0026middot;001)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGreer et al, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e721\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eO\\u0026amp;G/anaesthetics/paediatrics attendings/residents, certified obstetric/neonatal/midwifery nurses, certified/student anaesthetic nurses, navy hospital corpsmen, blood bank personnel, operating room personnel\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eOB-STaT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, maternal/neonatal resus,\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eImpact of OB-STaT on participant PPH treatment and maternal/neonatal resuscitation knowledge and teamwork\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e4-hour program\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre-training and post-training knowledge test, teamwork assessment (CTS), patient perception score\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Obstetricians trainees and attendings significantly improved knowledge test scores (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01)\\u003c/p\\u003e \\u003cp\\u003e- Improvement in overall mean CTS scores (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHirst et al, 2009\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eVietnam\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwifery/obstetric/neonatal service providers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eSCORPIO teaching method\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo evaluate the SCORPIO multidisciplinary teaching program to improve maternal and infant health\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3-day workshop\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003epost-training anonymous feedback forms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Workshops rated either good or excellent overall by all participants\\u003c/p\\u003e \\u003cp\\u003e- Participants reported that the content would help with clinical work and teaching was easy to understand\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKhot et al, 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e160\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical and nursing students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eShoulder dystocia (with neonatal resuscitation) and PPH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo evaluate key learning acquired by undergraduate medical/nursing students from the online ONE-Sim workshops\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-hour workshop\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eElectronic questionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported on themes of cognitive presence (e.g. Information exchange and reflective discourse), social presence (e.g. communicating vulnerability, collaboration) and teacher/educator presence (e.g. stepped learning, repetition)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKildea et al, 2006\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e175\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRAN\\u0026rsquo;s, AHW\\u0026rsquo;s, RN\\u0026rsquo;s, student nurses, enrolled nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eMEC course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation, breech birth, cord prolapse, shoulder dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eThe evaluation aimed to assess the overall impact of the course on participants\\u0026rsquo; knowledge, and their perception of the benefits to their own practice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2.5 day workshop\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-intervention questionnaire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eEvaluations demonstrate a highly valued program, well received and supported by remote health staff. Themes included: increase in confidence and a decrease in fear of childbearing women; increasing the participants\\u0026rsquo; understanding of maternity conditions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKogutt et al, 2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eObstetricians, labour and delivery nurses/technicians, neonatologist, neonatal nurse practitioner, NICU respiratory therapists, NICU nurses, BCU nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNeonatal resus\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo test the ability of the Johns Hopkins Hospital BCU to manage a pregnant patient in labour with an unknown respiratory illness and to deliver and stabilize her neonate without biocontamination\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-hour workshop\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eObjective measures to detect contamination, After-action reporting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- No evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise\\u003c/p\\u003e \\u003cp\\u003e- Valuable insights regarding patient transportation, patient care, specialized equipment considerations, safety and PPE, obstetric and neonatal considerations, and communication\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar et al, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e508\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical staff/ students (obstetricians, paediatricians, anaesthetists), midwifery staff/students, SCN staff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePROMPT - Victorian state version\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation, eclampsia, shoulder dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eEvaluate the implementation of the PROMPT simulation on participant acquisition of knowledge/skills, impact on clinical outcomes and organisational change to integrate PROMPT as a credentialling tool\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eHalf day programme\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003e1) Pre-test/post-test paper-based questionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported improvement in clinical and non-technical skills (teamwork, communication, leadership, prioritisation) in emergency situations\\u003c/p\\u003e \\u003cp\\u003e- Key learning themes include being prepared with a prior understanding of procedures and equipment, communication, leadership and learning in a safe, supportive environment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar et al, 2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e150\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eDoctors, midwives, medical students, midwifery students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim (Mobile)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eObstructed labour, breech birth, shoulder dystocia, PPH, neonatal resus of asphyxiated infant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eIdentify challenges and effectiveness of implementing ONE-Sim program\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e6-day course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre/post-workshop qualitative surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported key learning points were gaining knowledge and procedural skills, non-technical skills, a\\u003c/p\\u003e \\u003cp\\u003esystematic approach to obstetric and neonatal emergencies and learning in teams\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar et al, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNote: This is a follow up to the Kumar 2019 study\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u0026uarr;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u0026uarr;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo evaluate participant attitudes, perceptions of retention of learning, and application to clinical practice one year after a simulation workshop\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e\\u0026uarr;\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003e12 month follow up: Post-workshop up one-to-one interviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported enhanced leadership skills, effective learning in interprofessional teams, improved procedural skills\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLi et al, 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eSingapore\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e280\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eO\\u0026amp;G trainees (150), family medicine / anaesthesia / emergency trainees (112), nurses / midwives (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eCORE and CORE Lite\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eSevere pre-eclampsia, PPH, breech delivery, maternal resuscitation, shoulder dystocia, uterine inversion and twin delivery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eAudit to compare the confidence levels of participants in the management of obstetric emergencies based on their responses in the pre- and post-course questionnaires.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eConfidence Scores\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eOverall significant increase in confidence levels among participants in the management of obstetric emergencies post-simulation course (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLutgendorf et al, 2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e113\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eObstetric residents, midwives, labour and delivery nurses, corpsmen, anaesthesia providers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eAssess participant comfort with managing obstetric haemorrhage following our multidisciplinary in situ simulation training exercise\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-day course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre/post simulation participant self-reported comfort levels\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported higher comfort level in managing obstetric emergencies such as hypertensive emergencies, shoulder dystocia, PPH after simulation training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e- A decrease in the time to prepare simulated blood products over the course of the simulation was observed \\u003c/p\\u003e \\u003cp\\u003e- A decreasing trend of PPH cases (which continued after initiating the postpartum haemorrhage simulation exercise)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMadden et al, 2011\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eNorthern Ireland\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e200\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, paediatricians, anaesthetists, obstetricians, resuscitation officers, laboratory staff, other hospital staff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, cardiac arrest, cord prolapse, shoulder dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo investigate the effect of on-site, multi-professional simulated emergency drills on teamwork\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eRepeated observation/compilation of written notes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eThree main themes emerged: collaboration, communication and control. In every simulation exercise category post-evaluation analysis demonstrated effective change\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMalhotra et al, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia, overseas (not specified)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;400\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eOne-Sim (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eObstructed labour, foetal distress, neonatal resuscitation and PPH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eSome important lessons that were learned from the preliminary experience of these ONE-Sim workshops are detailed in this report\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2.5-3.5-hour workshops\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePreliminary experience/observations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eThe online workshops were well received by students and staff in Australia and overseas\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMeekeret al, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e170\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eLabour and Delivery RN, Special Care Nursery RN, surgical technician, anaesthesiologist, certified RN anaesthetist, obstetrics resident/attending, paediatrics attending\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eHPS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eShoulder dystocia, newborn resuscitation, maternal seizure, maternal resuscitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2 hours per simulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost workshop participant surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants reported improved communication (p\\u0026thinsp;=\\u0026thinsp;.031) and teamwork (p\\u0026thinsp;=\\u0026thinsp;.041) after simulation.\\u003c/p\\u003e \\u003cp\\u003e- Additionally, 81% of respondents believed that their ability to perform clinical skills improved.\\u003c/p\\u003e\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiller et al, 2008\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e700\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ePhysicians, nurses, support staff\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePlacental abruption, uterine rupture, PPH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo describe the experiential nature of in situ simulation for the participants\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-workshop (debriefing) self-reported participant/facilitator experiences\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participant evaluation provided insight into the communication lapses and team failures\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiller et al, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUganda, Kenya\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e318\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNurse midwife (55%), nurse (24%), clinical officer (11%), medical officer (7%), other (5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO, STT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePre-eclampsia, PPROM, spontaneous preterm delivery (with chorioamnionitis of a floppy/non-vigorous baby)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo understand how STT trainings impacted preterm birth knowledge and skill of providers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eVariable\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre and post training knowledge tests, clinical skills and teamwork assessment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Improved knowledge scores, communication techniques and preterm birth evidence-based practices\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMonod et al, 2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eSwitzerland\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e168\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, obstetricians\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eshoulder dystocia, PPH, pre-eclampsia, maternal BLS, neonatal resuscitation, operative vaginal birth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo investigate the influence of simulation training on four specific skills: self-confidence, handling of emergency situation, knowledge of algorithms and team communication\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1 day course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training questionnaire\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Participants gave higher Likert scale answers for questions on the four specific skills after 3mo (compared to immediately after the course).\\u003c/p\\u003e \\u003cp\\u003e- The improvement was statistically significant (\\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026le;\\u0026thinsp;0.05) except for team communication.\\u003c/p\\u003e\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePak et al, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTrauma attending/fellow/residents, obstetric attending/residents/RN\\u0026rsquo;s, NICU attending/fellow/RN\\u0026rsquo;s, neonatal respiratory therapist\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePregnant trauma patient: adult resus, neonatal resuscitation, emergency CS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo identify patient safety risks, a multidisciplinary in situ simulation drill was conducted that involved physicians and nurses from different specialties including trauma, obstetrics, neonatal intensive care, and emergency care.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training debriefing\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eAs a result of the drill, three patient safety concerns were identified by ED nursing staff including: a lack of familiarity of equipment and supplies, poor communication, and poor documentation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePauley et al, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eEngland\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, paramedics, MCA\\u0026rsquo;s, student midwives\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation, shoulder dystocia, cord prolapse, breech\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo assess the effectiveness of planned skill drills in the community\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eHalf-day training session\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training evaluation forms\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003ePositive response from participants who reported the simulation a more realistic environment for this workforce than that offered by hospital-based training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrasad et al, 2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e71\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical and midwifery students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, neonatal resuscitation, shoulder dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e65 mins\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePreliminary observations of facilitators\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eResearchers observe students reacting positively to online simulation with collaborative interactions, asking facilitators questions and sharing previous experiences / knowledge amongst each other\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrasad et al, 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAustralia (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e385\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical and midwifery students\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim (Online)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, Neonatal Resuscitation, Shoulder Dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e85 mins\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training survey\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Main themes from participant responses were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. \\u003c/p\\u003e \\u003cp\\u003e- Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. \\u003c/p\\u003e \\u003cp\\u003e- Midwifery students were most interested in interprofessional interaction whilst medical students were more concerned with developing clinical skills\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRosenberg et al, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eRwanda\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMidwives, nurses, physicians\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eEONC\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eProlapsed umbilical cords, delivery of twins, breech delivery, shoulder dystocia, and newborn resuscitation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eDevelop and implement a context-specific prehospital obstetrics and neonatal course for SAMU based on international best practices and form an instructor core for prehospital obstetrics education in the region by implementing a train-the-trainers program and studying the outcomes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-day course (EONC1, EONC2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre/post training 50 question assessment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eEONC1 median scores were 60% versus 92% (pre vs post), using matched-pair analysis of 20 participants. EONC2 median scores were 52% versus 96% (pre vs post), using matched-pair analysis of participants. A one-way analysis of variance mean square analysis showed that regardless of the baseline level of training for each participant, all trainees reached similar post-course assessment scores (F(\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e)\\u0026thinsp;=\\u0026thinsp;8.35, P\\u0026thinsp;=\\u0026thinsp;0.0059)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eShaw-Battista et al, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUSA\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3rd/4th year medical students, 1st/2nd year midwifery students, obstetric residents, paediatrics residents / advanced practice nurses, family medicine residents / advanced practice nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eFoetal bradycardia, cord prolapse following AROM with high vertex, shoulder dystocia, PPH\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eWe developed our curriculum with these critical components in mind and describe this ongoing project as an exemplar for educators and clinical leaders, with an overview of challenges and successes to inform adaptation to other settings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eNot reported\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eQualitative researcher preliminary observations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eSuggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStieglitz et al, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eGermany\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e174\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eMedical students (160), midwifery students (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003e-\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eShoulder dystocia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo demonstrate how the learning objectives for shoulder dystocia, listed in the National Competence Based Learning Objectives Catalogue for Medicine (NKLM, Germany) can be successfully taught in medical studies using a blended learning concept (e-learning\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eOne hour eLearning course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eEvaluation form and learning objectives\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e95.9% of the study participants met the required standards, i.e. achieved very good to adequate performance in simulation training.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVan der Scheer et al, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eUnited Kingdom\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e57\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e21 midwives, 25\\u003c/p\\u003e \\u003cp\\u003eobstetricians, 7 anaesthetists and 4 other professionals\\u003c/p\\u003e \\u003cp\\u003efrom five maternity units.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003e-\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eImpacted foetal head at CS birth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo evaluate a training package for managing IFH at caesarean birth with multiprofessional maternity teams.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eUp to 3 hours\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePost-training feedback in focus groups\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Over 95% of participants agreed that the training was relevant and helpful for their clinical practice and improving outcomes following IFH.\\u003c/p\\u003e \\u003cp\\u003e- Confidence in technical and non-technical skills relating to managing IFH was variable before the training (5% 92%agreement with the pre-training statements) but improved in nearly all participants after the training (71\\u0026ndash;100% agreement with the post-training statements).\\u003c/p\\u003e\\u003cp\\u003e- Participants and ethnographers reported that the training helped to: (i) better understand the complexity of IFH, (ii) recognise the need for multiprofessional training and management and (iii) optimise communication with those in labour and their birth partners.\\u003c/p\\u003e\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVarghese et al, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eObstetrics and newborn care providers (medical doctors, labour room nurses)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH, eclampsia, birth asphyxia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTested the feasibility, acceptability, and effectiveness of a \\u0026ldquo;skills and drills\\u0026rdquo; intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-day clinical skills refresher sessions\\u0026thinsp;+\\u0026thinsp;emergency drills (45mins each x once every 2mo)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eDelivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCE\\u0026rsquo;s), and qualitative in-depth interviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eKnowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49\\u0026ndash;57% (P\\u0026thinsp;=\\u0026thinsp;.006) and in newborn care, scores increased from 48\\u0026ndash;56% (P\\u0026thinsp;=\\u0026thinsp;.03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker et al, 2014b\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e450\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eGeneralist physicians, specialist physicians (obstetricians, paediatricians, anaesthesiologist, surgeons, neonatologist, perinatologist, internists), nurses\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eObstetrics haemorrhage, pre-eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eAssess the impact of PRONTO simulation training on process indicators\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3-day modules\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003e1) Pre/post-training knowledge, self-efficacy, \\u003c/p\\u003e \\u003cp\\u003e2) Teamwork scores\\u003c/p\\u003e \\u003cp\\u003e3) Achievement of strategic planning goals established during trainings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Significant increases in knowledge and self-efficacy were noted for both physicians and nurses (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001\\u0026ndash;0.009) in all domains. \\u003c/p\\u003e \\u003cp\\u003e- Teamwork scores improved and were maintained over a three-month period. \\u003c/p\\u003e \\u003cp\\u003e- A mean of 58.8% strategic planning goals per team in each hospital were achieved\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker et al, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eGuatemala\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e219\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eAuxiliary nurses, doctors, professional nurses, \\\"other\\\"\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eObstetric haemorrhage, neonatal resuscitation, shoulder dystocia, pre-eclampsia/eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eImpact of PRONTO on provider knowledge and self-efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre-training and post-training assessment and interview\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Improvement in knowledge and self-efficacy scores (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker et al, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e219\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eAuxiliary nurses, doctors, professional nurses, \\\"other\\\"\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eObstetric haemorrhage, neonatal resuscitation, shoulder dystocia, pre-eclampsia/eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eImpact of PRONTO on patient outcomes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5 months\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eFollow up neonatal mortality, maternal complications, and caesarean delivery rates\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e- Significant estimated impact of PRONTO on the incidence of caesarean sections (reduction) in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P\\u0026thinsp;=\\u0026thinsp;0.005) and in intervals measured at 4 (16% decrease, P\\u0026thinsp;=\\u0026thinsp;0.02), 8 (20% decrease, P\\u0026thinsp;=\\u0026thinsp;0.004), and 12 months\\u0026rsquo; (20% decrease, P\\u0026thinsp;=\\u0026thinsp;0.003) follow-up\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalton et al, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eGuatemala\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNot specified\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNot specified\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePRONTO\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNormal Birth, uterine atony, placenta praevia, cervical laceration, incomplete abortion, neonatal resus, shoulder dystocia with severe PPH, pre/eclampsia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo assess the effect of PRONTO on non-emergency delivery practices at primary level clinics in Guatemala.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e3-day modules\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eImplementation of practices known to decrease maternal and/or neonatal mortality and improve patient care\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eOverall, 25 and 17 births occurred in intervention and control clinics, respectively. Active management of the third stage of labour was appropriately performed by 20 (83%) of 24 intervention teams versus 7 (50%) of 14 control teams (P\\u0026thinsp;=\\u0026thinsp;0.015). Intervention teams implemented more practices to decrease neonatal mortality than did control teams (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Intervention teams ensured patient privacy in 23 (92%) of 25 births versus 11 (65%) of 17 births for control teams (P\\u0026thinsp;=\\u0026thinsp;0.014). All 15 applicable intervention teams kept patients informed versus 6 (55%) of 11 control teams (P\\u0026thinsp;=\\u0026thinsp;0.001). Differences were also noted in teamwork; in particular, skill-based tools were used more often at intervention sites than control sites (P\\u0026thinsp;=\\u0026thinsp;0.012)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWu et al, 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eChina\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eObstetricians (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e), midwives (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003e-\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eGentle birth, episiotomy on model of the perineum, shoulder dystocia, neonatal asphyxia resuscitation, emergency caesarean section, postpartum hemorrhage, and preeclampsia with seizures\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo explore the effects of simulation-based midwife training workshops and determine whether such a program can improve team collaboration and communication.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e2-day simulation training\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003eClinical Teamwork Scale (CTS)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eThe total median score of all items was significantly higher in the post-training group (median, 7.0 range, 4.0\\u0026ndash;9.0) than in the pre-training group (median, 5.0; range, 4.0\\u0026ndash;6.0; p\\u0026thinsp;=\\u0026thinsp;0.002).\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eZech et al, 2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eMexico\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e270\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eObstetricians, gynaecologists, anaesthesiologists, nursing staff, neonatologists, midwives\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eSimparteam\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePPH due to uterine atony, shoulder dystocia, uterine rupture during vaginal delivery, placental abruption (with floppy infant due to asphyxia), meconium aspiration syndrome (with pneumothorax), neonatal sepsis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eTo evaluate whether the standardised simulation-based training program \\u0026ldquo;simparteam\\u0026rdquo; for multiprofessional obstetric teams can improve staff\\u0026rsquo;s self-perceived emergency management skills and indirectly even affect the patient safety culture in hospitals that differ regarding the size and care level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e12 hours\\u003c/p\\u003e \\u003cp\\u003e(over 1.5 days)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre/post-training questionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003eStrong effects were found in the participants\\u0026rsquo; perception of their own competence regarding technical skills and handling of emergencies\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eZhong et al, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eIndia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e125\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNurses, obstetric/neonatal doctors, students, \\\"other health professionals involved during childbirth)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eONE-Sim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eNormal and obstructed labour, breech birth, shoulder dystocia, PPH, neonatal resus (asphyxiated newborn)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eAssessing contribution of ONE-Sim workshop in management of obstetrics and neonatal emergencies, as perceived by participants.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e4 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c11\\\" namest=\\\"c10\\\"\\u003e \\u003cp\\u003ePre-workshop and post-workshop qualitative surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e \\u003cp\\u003e- Increased confidence in ability to manage emergency scenarios\\u003c/p\\u003e \\u003cp\\u003e- Improving individual and synergistic performance in teams\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e \\u003cp\\u003e-\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003cspan type=\\\"SmallCaps\\\" class=\\\"SmallCaps\\\" name=\\\"Emphasis\\\"\\u003eTYPES OF INTERPROFESSIONAL SBT PROGRAMS\\u003c/span\\u003e\\u003c/h2\\u003e \\u003cp\\u003eThere were several different SBT programs identified in the studies with the majority (n\\u0026thinsp;=\\u0026thinsp;14) not following a specific program name. From the remainder, the most reported training programs included variations of the Obstetrics and Neonatal Emergency Simulation (ONE-Sim) (n\\u0026thinsp;=\\u0026thinsp;7) program, the Simulation and Team Training for Obstetric and Neonatal Emergencies (PRONTO) program (n\\u0026thinsp;=\\u0026thinsp;6) and the Enhancing Training and Technology for Mothers and Babies in Africa (ETATMBA) program (n\\u0026thinsp;=\\u0026thinsp;2). There was a significant variation in the duration and structure of training across these programs, including 65\\u0026ndash;120 minute online workshops, longer simulation modules or mentorships and training sessions provided at various intervals over several months. There were a wide variety of obstetric and neonatal emergencies simulated across programs including but not limited to the management of PPH (n\\u0026thinsp;=\\u0026thinsp;27), shoulder dystocia (n\\u0026thinsp;=\\u0026thinsp;25), neonatal resuscitation (n\\u0026thinsp;=\\u0026thinsp;22) and pre/eclampsia (n\\u0026thinsp;=\\u0026thinsp;13). The programs involved IP SBT sessions where team members engaged in a simulated emergency scenario and were subsequently given performance feedback from senior medical, nursing or midwifery staff. In some studies, local clinicians were taught how to deliver IP SBT programs within their own facilities. Post intervention data was mainly qualitative, consisting of post training surveys and questionnaires. A limited number of studies examined the impact of clinical outcomes, however, given their small number and heterogeneity we could not perform a meta-analysis.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e\\u003cspan type=\\\"SmallCaps\\\" class=\\\"SmallCaps\\\" name=\\\"Emphasis\\\"\\u003eLOCATIONS\\u003c/span\\u003e\\u003c/h2\\u003e \\u003cp\\u003eThe Global Distribution of IP SBT programs is presented in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. The IP SBT programs reported were spread across 18 different countries across all major continents. These included centres in Asia (n\\u0026thinsp;=\\u0026thinsp;9), Europe (n\\u0026thinsp;=\\u0026thinsp;5), Oceania (n\\u0026thinsp;=\\u0026thinsp;5), North America (n\\u0026thinsp;=\\u0026thinsp;13) and Africa (n\\u0026thinsp;=\\u0026thinsp;8). The highest number of reported studies by country was in the USA (n\\u0026thinsp;=\\u0026thinsp;8), India (n\\u0026thinsp;=\\u0026thinsp;6) and Australia (n\\u0026thinsp;=\\u0026thinsp;5) respectively.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePARTICIPANTS\\u003c/h2\\u003e \\u003cp\\u003eAcross the 40 studies, individuals from 18 countries were participated in IP SBT programs, coming from a range of different occupations and training levels. Participants included health professionals directly involved during childbirth (Obstetricians, Neonatologists, Paediatricians, Nurses and Midwives) as well as other health professionals such as General Practitioners, Anaesthesiologists, Internal Medicine Specialists and Allied Health staff (Paramedics, Army Corpsman and Respiratory Therapists). Ten SBT programs also recruited non-clinical staff including blood bank and operating room personnel, navy corpsmen and other hospital staff. In ETATMBA SBT sessions, an additional role of Non-Physician Clinicians (NPCs) or Associate Clinicians (ACs) was identified. This describes trained clinicians present in many African nations with medical and nursing skills who look after women and newborns in regional and rural centres (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). The exact number of individuals within each discipline participating in the IP SBT sessions varied across the 40 studies. Overall, the most frequently participating clinician group was medical professionals (n\\u0026thinsp;=\\u0026thinsp;26 studies), followed closely by nurses (n\\u0026thinsp;=\\u0026thinsp;20 studies) and midwifery staff (n\\u0026thinsp;=\\u0026thinsp;20 studies). The facilitators of these IP SBT sessions also varied in their level of skill and expertise in SBT provision. Clinical experience of participants ranged from senior registered practitioners (consultants and fellows) to student trainees.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTHE SIMULATION ENVIRONMENT\\u003c/h2\\u003e \\u003cp\\u003eA realistic and safe simulation environment in the IP SBT training programs was noted across the included studies. In particular, Kumar (2021) highlighted that by realistically mimicking clinical practice in a controlled setting participants could strengthen their learnt skills, feel more comfortable and less rushed (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Wu (2024) also commented on how participants felt less judged in a simulation setting compared to other training methods or programs (\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFour of the included studies conducted online simulation workshops, rather than face to face in person sessions. In Malhotra (2021) there was an overall positive response to online SBT training from both clinicians and students across the globe, with a focus on its benefit during the COVID-19 pandemic (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e). Feeling connected, or \\u0026lsquo;connectivism\\u0026rsquo; was mentioned in a number of studies and it was seen as an important concept that allowed participants to engage with the provided learning (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). Malhotra (2021) additionally noted that participants felt that watching livestreamed scenarios appeared to be more effective than watching pre-recorded scenarios during online workshops (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eMultiple factors were thought to impact on the efficacy of the various simulation programs implemented in the 40 studies. These included (but were not limited to) the type of workshop, the type of simulation, timing of simulation sessions and the role of debrief. Certain workshops like PRONTO were used across multiple studies. Walker (2015) suggests that the PRONTO program showed such strong results and was so well received in Guatemala that it got further funding to expand IP SBT provision to other facilities beyond those that were initially planned (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e). Rosenberg (2021) reflects that the EONC course, taught by local stakeholders, leant itself to creating interdisciplinary connections between prehospital providers and their hospital colleagues, with relation to obstetric and neonatal emergencies (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Walker (2014) preferred high fidelity simulation whilst Miller (2023) found that low fidelity simulation training that was focused on clinical mentorship, communication and teamwork was also helpful, in addition to being less costly (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). Finally, Shaw-Battista (2015) noted that IP SBT participation can be optimised when scenarios have a clinical picture that requires multidisciplinary input (\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e). They also suggested that there is likely to be more uptake if such training sessions occur at the time of shift change or have roles for both students and clinicians (\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCLINICIAN SELF REPORTED OUTCOMES\\u003c/h2\\u003e \\u003cp\\u003eClinician self-reported outcomes included teamwork and collaboration, confidence, preparedness for practice, communication, knowledge, debriefing and a shared mental model. Across the studies, the single most recurrent theme was the role of IP SBT in improving teamwork. Miller (2008) suggests that teams make less mistakes compared to individuals (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). They also highlight that task training allows individuals to learn how to perform high quality work independently but team training enables individuals to see and develop the behaviours that are required to work effectively in an IP setting (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eParticipating clinicians reported that following IP SBT they more clearly understood the basics of teamwork (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). Anderson (2005) commented that doing multidisciplinary acute obstetric emergency drill training made it easier for the participants to visualise how they would realistically work together if an actual emergency were to occur (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Kumar (2021) noted that participants appreciated being able to work together as a team, better understand each other\\u0026rsquo;s roles and provide others with support, moving away from a culture where help seeking was seen as failure (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Madden (2011) noted that individuals were good at communicating within their own professional team, but not as good at communicating with participants from other clinical areas or teams (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). For example, the midwife had to repeatedly communicate the same message to various professionals from different disciplines as they arrived to a scenario and due to this poor IP communication there were delays in care provision (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Pauley (2016) recognised the importance of interdisciplinary obstetric and neonatal management outside the hospital, extending to the role of paramedics. Being present in obstetric and neonatal IP SBT scenarios was thought to provide paramedics with a better understanding of what inpatient teams felt was helpful prior hospital arrival (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e). Van der Scheer (2023) showed that IP SBT allowed all interprofessional team members to better appreciate each other\\u0026rsquo;s challenges and recognise what they could do to help, thereby raising awareness amongst participants that managing emergency obstetric and neonatal conditions requires a well-integrated multidisciplinary team (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eTwo studies specifically showed an increase in clinician confidence in managing obstetric emergencies (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e). This partly resulted from participants having more a more comprehensive understanding of their surroundings, greater familiarity with local protocols and equipment and a learned process to synthesise a more systematic approach. Self-efficacy improved through situational awareness, with Bhatia (2023) suggesting that practitioners become more situationally aware through SBE (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Technical skills also improved, with Zech (2017) noting that participating in IP SBT resulted in a long term skill acquisition, which was sustained at 6 months on some occasions in their study (\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003ePreparedness for practice was an important clinician self-reported theme that emerged in this systematic review. Anderson (2005) discussed how practicalities such as the equipment on the labour ward being organised in a better manner, placement of laminated protocols in each delivery room, presence of more accessible telephones, and individuals knowing where the defibrillator or eclampsia box was located helped practitioners feel more prepared (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Kumar (2018) notes that IP SBT prepared participants for complex situations like eclampsia, neonatal resuscitation, shoulder dystocia in addition to learning the relevant pathways of care escalation at their service in an emergency (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eGaining knowledge was an important part of IP SBT. For example, Adams (2024) reports that the most useful topics covered in their IP SBT sessions were neonatal resuscitation, maternal resuscitation, preeclampsia and eclampsia (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). Afulani (2020) showed that there were improvements in post-test scores on topics like neonatal resuscitation, maternal and neonatal sepsis, placenta praevia, preeclampsia and eclampsia (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Meeker (2018) showed that 81% of their participants who completed survey responses felt that their clinical performance in an emergency improved following attendance of IP SBT training (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). Finally, Miller (2023) showed that following PRONTO simulation and team training there was a statistically significant improvement in knowledge scores from 51-72.6% (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.01) when comparing the pre and post intervention multiple choice test responses in the neonatal, maternal and communication question categories (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eManagement algorithms and debriefing were two other important areas reported on. Van der Scheer (2023) suggested that management algorithms were useful in allowing IP teams to build a shared mental model and allowed those who entered the theatre later to quickly establish the situation (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e). Finally, Miller (2008) reported that debriefing within the IP team allowed individuals to learn by doing, and established \\u0026lsquo;active failures\\u0026rsquo; or \\u0026lsquo;latent conditions\\u0026rsquo; present in the simulated setting that could contribute to improper management in real emergencies (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). Reflections from debriefing in Miller (2008) also played a role in developing an IP training curriculum for teams (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). Ultimately, effective IP SBT led to an improvement in a number of clinician reported domains across the 40 included studies.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePATIENT AND ORGANISATIONAL OUTCOMES\\u003c/h2\\u003e \\u003cp\\u003ePatient outcomes documented in the included studies were newborn mortality, intrapartum stillbirth, active management of third stage, need for caesarean section and postpartum haemorrhage. A meta-analysis was not conducted in this review as quantitative outcomes were difficult to measure across the studies, with a significant number of qualitative studies being included. Organisational outcomes included a better understanding of specialised equipment, personal protective equipment (PPE) training, reflections on transportation, protocol development and provision of informed and safe practice. Walker (2014) promoted facility-based quality improvement as part of their SBE training (\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). Malhotra (2021) demonstrated that using PPE and putting it on and removing it in the correct manner raised issues and questions with its use, and addressing these questions assisted with the development of team communication skills (\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eA few studies highlighted the importance of changes that need to occur at a systems level. Other studies focused on identifying gaps in IP staff training and how these could be optimised. For example, in Lutgendorf (2017) it became apparent that not everyone involved in emergency scenarios knew the process to request and obtain emergency blood products which led to additional staff training in a timely manner (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Improved understanding and development (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e) of protocols that led to improved patient outcomes was discussed in several studies as well. Varghese (2016) highlighted a number of organisational challenges identified through IP SBT including an inadequate number of trained staff, a rotating nursing workforce and inconsistencies in the drugs and supplies available for clinical practice (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). All in all, IP SBT highlighted patient and organisation factors that could be addressed to improve obstetric and neonatal care provision globally.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRISK OF BIAS\\u003c/h2\\u003e \\u003cp\\u003eRisk of bias assessment was completed using the ROBINS-1 tool for quantitative non-randomised studies (16 studies) and the JBI tool for qualitative studies (24 studies). The number of quantitative and qualitative studies is summarised in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e. The qualitative studies were all included using the JBI checklist. For the quantitative studies the ROBINS-1 tool showed that overall, 9 studies were associated with moderate risk of bias and 6 studies were associated with serious risk of bias as seen in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e. The main area of concern was bias in the measurement of outcomes with an overall moderate to serious level of bias across the included studies in this domain.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u0026ndash; Overview of quantitative and qualitative studies Place in text: Line 379, page 14\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eArticle (Author, Publication Year)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudy Type\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eOutcome\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eRisk of Bias Tool\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdams 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnsure/Mixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSurveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAfulani 2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eKnowledge; Self-Efficacy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnderson, 2005\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBhatia, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSurveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDettinger, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eKnowledge; Self-Efficacy; Teamwork\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEllard, 2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eInterviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEllard, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eMaternal/Neonatal Health Indicators\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGomez, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eNeonatal Mortality\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGreer, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eKnowledge; Teamwork\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHirst, 2009\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKhot, 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKildea, 2006\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKogutt, 2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAfter Action Reporting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar, 2019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSurveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eKumar, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eInterviews\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLi, 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eConfidence Scores\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLutgendorf, 2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eComfort Levels\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMadden, 2011\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eReported Observations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMalhotra, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnsure/Mixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePreliminary Observations\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMeeker, 2018\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiller, 2008\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMiller 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePre and post knowledge quiz, % Evidence Based Practices performed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMonod, 2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePak, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eDebriefing sessions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePauley, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrasad, 2020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eResearcher observations of recordings\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePrasad, 2022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eThematic analysis of questionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRosenberg, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAssessment quiz pre and post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eShaw-Battista, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eQuestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStieglitz 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePerformance assessment post simulation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003evan der Scheer, 2023\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eConfidence Scores, Feedback\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVarghese, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAssessment quiz pre and post\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker, 2014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnsure/Mixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1. pre/post assessment 2. questionnaire 3. assessor scores\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker, 2015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePre and post questionnaires: knowledge via quiz (quant) and self-efficacy scores (qual)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalker, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eperinatal mortality at 12-month \\u0026amp; death rate from obstetric haemorrhage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWalton, 2016\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQuantitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eBirth observations - ebps\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWu, 2024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnsure/Mixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eClinical Teamwork Scale (CTS)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eROBINS-I\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eZech, 2017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eQualitative\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003equestionnaires\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eZhong, 2021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnsure/Mixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFree Text Surveys\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eJBI\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBias due to confounding\\u003c/h2\\u003e \\u003cp\\u003e11 studies demonstrated a low level of confounding and 5 studies indicated a moderate level of confounding. Confounding tended to be a result of access to resources, differences in facility staffing, underlying illness, baseline rate of complications, prior clinical exposure and training.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSelection bias\\u003c/h2\\u003e \\u003cp\\u003e14 out of the 16 studies had a low level of selection bias. Selection bias was most prominent in Greer (2023), where only about 50% of workshop participants went on to study enrolment afterward. There was also an unequal distribution of participants between specialties in this study, with lower rates of participation from paediatrics and anaesthesia, with the study itself reporting that selection biases could have affected the knowledge results (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBias in the classification of intervention\\u003c/h2\\u003e \\u003cp\\u003eThere was a low level of bias across all the included studies assessed by the ROBINS-1 tool in this category.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec22\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBias in deviations from the intended interventions\\u003c/h2\\u003e \\u003cp\\u003e13 of the 16 studies exhibited a low level of bias in deviations from the intended intervention. Of note, in Stieglitz (2023), participants completed varying amounts of the e-learning module prior to participating in the simulation session, revealing a serious deviation from the intended intervention (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cdiv id=\\\"Sec23\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eBias due to missing data\\u003c/h2\\u003e \\u003cp\\u003e3 of the 16 studies had significant data gaps which contributed to a serious risk of bias in this category. Additionally, 3 other studies had moderate risk of bias due to missing data, with the remainder of the studies data being largely complete. For example, in Dettinger (2018), of the 182 participants, only 165 completed the first training module and only 148 completed the second training module (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). In Gomez (2018), only 50% of participants were assessed at the 1-year mark, leading to significant missing data in assessing the second aim of this study which was retention of knowledge (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec24\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eBias in the measurement of outcomes\\u003c/h2\\u003e \\u003cp\\u003eBias in the measurement of outcomes was the subcategory that was most significant when considering the included studies. 13 of the 16 studies had a moderate level of outcome measurement bias and 2 had serious risk of bias (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e). Only 1 study had a low risk of bias (\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e). Some examples of bias in the measurement of outcomes included lack of blinding, subjectivity due to self-reporting of outcome measures, an incomplete dataset and outcome assessors being aware of the intervention provided.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec25\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eBias of the selection of reported result\\u003c/h2\\u003e \\u003cp\\u003eThere was a low of level of reporting bias in 15 of the 16 studies. In Ellard (2016) there was incomplete outcome data on one of the primary outcomes leading to a moderate level of bias in the selection of the reported result (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eIn the context of high global neonatal and maternal mortality, this systematic review of 40 studies evaluated the current literature on IP SBT in obstetric and neonatal emergencies, with a focus on the prevalence and effectiveness of IP SBT in these fields. They key outcomes focused on the role of the simulation environment, participant self-reported learnings and impacts at an organisational and hospital level. The simulation environment was seen by participants as safe, supported and realistic. IP SBT improved practitioner teamwork and communication skills whilst highlighting gaps in knowledge and skills. At an organisational level, IP SBT led to identification of equipment and protocol gaps. We also reviewed limitations of IP SBT training and looked to possible future directions of research.\\u003c/p\\u003e \\u003cp\\u003eA key outcome of this systematic review was the integral role that SBT plays in developing IP team skills and behaviours in acute obstetric and neonatal emergencies. Whilst we could not establish causality, it appears that the improvement in team skills is present in both high and low-income settings and with low and high-fidelity simulation equipment. Several studies in other areas of healthcare outside of obstetrics and neonatology corroborate this, having shown that SBE training has contributed to teamwork and communication development in other fields. An example of this is a recent systematic review and meta-analysis of randomised control trials (RCTs) by Sezgin and Bektas in 2023 evaluating the effectiveness of SBT programs amongst healthcare students. The meta-analysis in this paper showed a statistically significant improvement in teamwork and communication skills through IP SBT training (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e). Similarly, In Greer (2023) it is notable that in the post-hoc analysis which corrected for comparators showed that Clinical Teamwork Scale (CTS) scores increased significantly from pre-intervention to post-intervention in all categories except the \\u0026rdquo;other/patient friendly\\u0026rdquo; category (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Kiessling (2022) showed a statistically significant improvement in overall participant confidence (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001) in an IP team environment as a result of SBT in emergency medicine, with the these improvements lasting over a 6-month period (\\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e). In Bhatia (2023), when referring to situation awareness and skill development in SBT, one participant said:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;... As I got to know and practice how to coordinate a team, [I learned that] we can't manage alone [in] such emergencies\\u0026hellip;\\u0026rdquo; (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eA participant in Khot (2022) suggests that:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;An interprofessional workshop like this helps us know the importance of each team member irrespective of qualification,\\u0026rdquo; (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eand that\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;This i.e. interprofessional learning was the best part of the workshop.\\u0026rdquo; (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eStudies like Pauley (2016) that included participants other than midwifery and medical staff as part of the IP team also had a positive experience. A midwife in this study said it was:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;\\u0026lsquo;Really helpful to have paramedics present to help understand how we work alongside each other in emergencies. As a newly qualified midwife, good to prompt me to think about managing emergencies in community.\\u0026rdquo; (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eTeamwork also contributed to the preparation process for emergencies. In Varghese (2016) drill training prompted staff to work together to prepare emergency trays for PPH. One participant said:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;Prior to the training we were not aware of effective teamwork\\u0026hellip;some of us would have forgotten a few things, but yesterday [during PPH case management drills] as it was teamwork, even if one of us forgot something, others would remind them about those things.\\u0026rdquo; (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eLeadership was reflected on by Madden (2011) who suggested that a single leader is insufficient to provide the best possible clinical outcomes in an emergency situation and each health professional is responsible to work effectively within the team (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e). Finally, in Walton (2016) we can see that the PRONTO training program overall had a positive impact in Guatemala, with SBA\\u0026rsquo;s at intervention sites providing more patient-centred care, use more evidence-based medicine, and implementing more communication and teamwork tools compared to the participants in the control sites (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eDevelopment of communication skills through IP SBT was another key outcome. In Afulani (2020) participants noted the importance of an IP team in facilitating good communication and vocalising, thereby preventing medical errors. One participant said:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;It was great because especially like the think out loud...maybe if you are working with your colleague, and you have something and are doing it to the patient, if you say it out loud your colleague will know what you are doing or what you are thinking. Because you may be thinking that what you think is the correct thing while you are doing the wrong thing.\\u0026rdquo; (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn Meeker (2018), there was a statistically significant improvement in both teamwork (p\\u0026thinsp;=\\u0026thinsp;0.041) and communication (p\\u0026thinsp;=\\u0026thinsp;0.031) following high fidelity IP SBT (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). In Miller (2023), use of certain communication strategies in IP SBT in Kenya and Uganda saw a 16.8% increase in participants performing actions like calling for help and thinking out loud, both techniques that were used in over 90% of the simulations (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Pak (2015) identified significant gaps in communication which led to confusion, doubling up of tasks and delays which subsequently led to the implementation of \\u0026lsquo;corrective actions\\u0026rsquo; (\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e). For example:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eEpinephrine was ordered by an ED resident but the order was not directed to a specific nurse. Two nurses stepped away to draw up the medication, with no verbalization by either nurse as to who would carry out the order. Time was wasted when the ED physician clarified whether the medication had been administered, and the two nurses had to sort out what was done for the patient. (\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eOnline learning was perceived by some as a barrier to effective communication, and helpful by others. In Prasad (2022), one participant said:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;It feels more awkward to participate on zoom and communication can sometimes be hampered.\\u0026rdquo; (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eHowever, other participants in the same study reflected that online IP SBT:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;\\u0026ldquo;\\u0026hellip;was good at showing us how midwives, obstetricians, junior trainees and paediatricians all work together and have designated jobs and how they communicate most effectively!\\u0026rdquo; (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u0026ldquo;By attending the zoom, I have had an opportunity to observe the communication and roles among different health professionals, which could be quite hard when attending in person.\\u0026rdquo; (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eAnother important outcome identified in this review, was the role of IP SBT in improving patient and healthcare outcomes. For example, in Ellard (2014), one participant noted that:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;We used to have a lot of neonatal deaths because of poor skill of resuscitation before ETATMBA, because easily giving up...We\\u0026rsquo;ve actually seen that the babies that we then used to say no\\u0026hellip;have survived, actually very healthy babies.\\u0026rdquo; (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eEllard (2014) additionally noted the importance of knowledge and skill acquisition in an IP team setting to improve patient outcomes, alongside its role in building confidence:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;\\u0026hellip;we are really following the partogram and we are really taking action on each and every deviation from the normal. Not only ETATMBA students but even the nurses. So, we are working together now.\\u0026rdquo; (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e)\\u003c/p\\u003e\\u003cp\\u003e\\u0026ldquo;I applied the B-lynch suture, with my colleague another ETATMBA trainee...we applied it and the patient actually, stopped bleeding. The patient actually went home\\u0026hellip;was discharged from the facility...it gave me courage\\u0026hellip;\\u0026rdquo; (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eIn Gomez (2018) there was a significant reduction in newborn mortality from one month to the next over the one year long low dose high frequency training (LDHF) intervention period, alongside a drop in the rate of stillbirths (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Moreover, Lutgendorf (2017) observed that through running IP SBT it became apparent there were \\u0026lsquo;system improvements\\u0026rsquo; that needed to occur at a hospital level that could prevent negative impacts on patient health outcomes (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). For example, during one of IP SBT exercises, it was identified that tranexamic acid and colloid resuscitation fluids were not readily available in their usual location on the ward. Due to this drill, these problems were rectified prior to a \\u0026lsquo;near miss\\u0026rsquo; or a negative patient outcome occurring (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). Miller (2008) through IP SBT identified several \\u0026lsquo;teamwork failures\\u0026rsquo; that were subsequently addressed. These included a lack of situational awareness, closed-loop communication, use of standardised communication measures, a shared mental model, protocol adherence and process issues between departments (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e).. In Miller (2023) there was a notable improvement in the knowledge and practice of sepsis management and a 34% decrease in stillbirth and neonatal mortality together when comparing intervention and control facilities (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Rosenberg (2021) affirmed similar positive findings in their Rwandan IP SBT workshops, where a paired t test comparing pre-workshop and post-workshop knowledge scores showed a statistically significant increase following the EONC1 and EONC 2 training programs (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.0001) (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Thus, it is evident that the implementation of IP SBT contributes to improved patient and healthcare outcomes through knowledge development, team skills and system improvements.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec27\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLIMITATIONS\\u003c/h2\\u003e \\u003cp\\u003eAcross the 40 included studies there were several limitations. To begin, a meta-analysis was not performed due to significant data gaps and lack of quantitative data related to clinical patient outcomes across the studies. Additionally, tools assessing qualitative outcomes in IP SBT were of a variety, and more common tools (e.g. Likert scores) were not used consistently across all the included studies. Limitations such as this made it challenging to draw comparisons between various IP SBT programs.\\u003c/p\\u003e \\u003cp\\u003eAnother limitation was the significant variability between simulation programs provided across the studies, with regards to the simulation fidelity, structure, modality and facilitators. Whilst many studies suggested high fidelity simulation training was more efficacious, Kumar (2019) showed that low-cost simulation devices, such as mobile simulators, were also successful in providing cost-effective training to countries with fewer resources (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). Varghese (2016) reported that there was an inadequate monitoring system for feedback (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). A limitation to online learning identified by Prasad (2022) was that of learners being unable to practice procedural skills (\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e). The quality of trainers also varied significantly, including experienced obstetricians and neonatologists who were key members of ONE-Sim workshops in Bhatia (2023) (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e) to individuals who had been trained as peer practice coordinators (PPCs) to lead simulations sessions in Gomez (2018) (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Accounting for the above factors, the quality of education provision in the simulation setting needs to be further assessed with a goal towards standardisation, as it will likely impact both qualitative and quantitative outcomes.\\u003c/p\\u003e \\u003cp\\u003eThere were additional limitations with selection, outcome and reporting bias. For example, Zech (2017) had a small sample size which contributed to selection bias (\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e). There was an imbalance of the various practitioners within the interdisciplinary teams in Meeker (2018) (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e). Walton (2016) suggested that those who participated in PRONTO training may have been more motivated to practice their learnt skills than those who didn\\u0026rsquo;t, contributing to bias in outcome assessment (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e). Variations in knowledge gains secondary to IP SBT training were noted, where in Greer (2023) obstetric participants had significant increases in their knowledge following training, whilst knowledge scores were similar from pre-training to post-training for other specialties like family medicine, nursing, anaesthesia and paediatrics (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). This could be related to several factors including that the workshops were targeted towards the skill set and knowledge base of one specialty or that there was a variation in practitioner presence and interest across the different specialities. Many studies also had loss to follow up leading to attrition bias (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). Reporting bias was also noted. For example, in Ellard (2014) there was some concern that participants would only report and feedback what they thought was considered \\u0026lsquo;socially acceptable\\u0026rsquo; to the team (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFinally, provision of minimal SBT sessions and short term follow up raises limitations in the maintenance of learnt skills and their translatability to clinical practice. Most of the included studies only measured learnings immediately after training and in a simulated context. This short duration of programs, lack of sustainability or evidence of transability to real life clinical practice and lack of opportunity for ongoing education were all future areas of change indicated by many studies. In Afulani (2020), one participant said:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e\\u0026ldquo;\\u0026hellip;it is difficult for one person to implement change, but if a lot of people buy into the idea or get the knowledge, it is easier to do it. Because if I am there and I do it for shift, and I am going, and no other person can continue to do it, the purpose [of the training] will be defeated. But if other people get to know and have the skill then whatever you need from them they will continue, and you will have the continuity of care which is good for the patient.\\u0026rdquo; (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e)\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eSome studies also suggested that more analysis is required to see if the program provided is relevant to the needs of the area and supported the idea of local facilitators being taught to run IP SBT sessions. For example, Hirst (2009) ensured that the learnings provided by the SCORPIO workshop were both relevant to the local Vietnamese province and were provided in a culturally sensitive manner, and they achieved this by carefully assessing the community\\u0026rsquo;s needs and liaising with local health professionals (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e). In Kildea (2006), 85 practitioners in a remote setting completed to a \\u0026lsquo;needs assessment\\u0026rsquo;, the responses to which then helped determine the content and delivery for the MEC IP SBT program in rural Australia (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e). Finally, a few studies questioned whether learning in simulation translated to clinical practice and actually improved clinical outcomes (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR29 CR30\\\" citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e) whilst others suggested that IP SBT is translatable into real life clinical practice (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e). This was an outcome measure that was not consistently assessed across the included studies.\\u003c/p\\u003e \\u003cp\\u003eUltimately, more research and implementation of IP SBT training globally is required to increase knowledge, awareness and outcomes for practitioners and patients. While IP SBT is becoming more widely taught, there are gaps in the literature regarding efficacy, type of workshop, individualised training, benefits of local trainers, translatability to real life practice and cost effectiveness of such training programs globally, especially in obstetrics and neonatology. Together, these limitations suggest the need for further studies in this area with repeated IP SBT workshops, quantitative outcome assessment and longer follow-up periods.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec28\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFUTURE DIRECTIONS\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec29\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eOnline vs face to face IP SBT\\u003c/h2\\u003e \\u003cp\\u003eStandardisation of obstetric and neonatal emergency IP SBT provided globally needs to occur, and this could be achieved through online training. Online simulation training has shown improvements in practitioner outcomes (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR29\\\" citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e). Stieglitz (2023) suggests that blended learning should be increasingly used to safely manage emergencies that rarely occur in clinical practice (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e). For example, in this study, participants were first provided approximately an hour of theoretical e-learning on shoulder dystocia. This was followed by the face-to-face component of this SBT program where the previously learned knowledge was applied on a birth stimulator in a shoulder dystocia simulation (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e). Moving forward, as Anderson (2005) suggests, it would be beneficial to conduct research that evaluates a range of training methods (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e) to better understand the efficacy of SBT, both face to face and online.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eVideo based learning\\u003c/h3\\u003e\\n\\u003cp\\u003eIn some studies, such as Greer (2023), simulation sessions were recorded using GoPro cameras. These recordings were then used kept as backup and reviewed if\\u0026thinsp;\\u0026lt;\\u0026thinsp;80% of the required items were assessed during the live simulation itself (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). It appears that video recordings have the potential to enable practitioners and facilitators to re-review simulation performance and may provide a better analysis of gaps and assist with the debrief process. Further studies need to be undertaken to analyse this whilst being cognisant of and ascertaining any relevant issues with related to consent and privacy.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec31\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eTraining local stakeholders to facilitate SBT provision\\u003c/h2\\u003e \\u003cp\\u003eRosenberg (2021) suggests that interventions that are focused on local stakeholders are likely to have greater uptake and be more successful (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Khot (2022) suggests a model where the \\u0026lsquo;learner becomes the educator\\u0026rsquo; (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). In this systematic review, studies that included courses taught by local stakeholders (e.g. the EONC course in Rwanda in Rosenberg (2021)) allowed for strengthened IP connection within and outside the hospital (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Here, creating a group of local teachers meant that in the future further training sessions can be conducted across the country and other countries within that region if feasible (\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). Ellard (2014, 2016) suggest that training more NPCs in areas of healthcare workforce shortages, where feasible from a resource perspective, (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e) is likely to significantly improve care provision in areas with limited physician and midwifery staffing (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec32\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eOngoing training to aid translation into practice\\u003c/h2\\u003e \\u003cp\\u003eA common theme that emerged across the included studies was participants\\u0026rsquo; desire for additional training sessions and the inclusion of more practitioners within the SBT sessions (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e), suggesting that this would lead to an improvement in long term outcomes (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). Future SBT provision should aim to review whether sustained IP SBT training across multiple sessions and sites further improves practitioner and patient outcomes in the longer term.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec33\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eStandardisation, feasibility and cost effectiveness analysis\\u003c/h2\\u003e \\u003cp\\u003eThis review has revealed that whilst several benefits exist in the provision of IP SBT, there needs to be further consideration from a feasibility, cost effectiveness, practicality and clinical outcomes perspective. Global standardisation of IP SBT is likely to be difficult to achieve in the context of different types of practitioners, varying skillsets, resource availability and funding limitations. Our systematic review suggests that SBT is emerging in its prevalence globally with efficacies in practitioner, organisational and clinical outcomes. Future work could aim to review the cost effectiveness of including IP SBT programs in different countries as a standardised component of clinical obstetric and neonatal training and practice for healthcare staff.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"CONCLUSIONS\",\"content\":\"\\u003cp\\u003eThis review systematically evaluated the available evidence for IP SBT and the impact of its implementation on obstetric and neonatal care outcomes across the globe. In both qualitative and quantitative studies, this review has demonstrated that the use of SBT programmes has led to improvements at clinician, patient and organisational levels. Broader scale implementation of IP SBT programs across the globe in obstetrics and neonatology is necessary and is likely to translate into higher quality care as well as improved practitioner and patient outcomes.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eED, emergency department; EONC, Emergency Obstetrics and Neonatal Course; ETATMBA, Enhancing Training And Technology for Mothers and Babies in Africa; GRADE, Grading of Recommendations Assessment, Development and Evaluation; IP, interprofessional; JBI, Joanna Briggs Institute; PPE, personal protective equipment; PPH, post-partum haemorrhage; PRONTO, Simulation and Team Training for Obstetric and Neonatal Emergencies; ROBINS, Risk Of Bias In Non-randomised Studies-of Interventions; SBE, simulation-based education; SBT, simulation-based training.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eContributions of the authors:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eM.B.: conception and design, data collection and assembly, data interpretation and analysis, risk of bias assessment, manuscript writing and editing. K.Z.: literature searching, data collection and assembly, risk of bias assessment, manuscript writing. J.S.: data collection and assembly, risk of bias assessment, manuscript writing. E.P.: manuscript editing, supervision. A.K.: conception, manuscript editing. A.M.: conception and design, manuscript editing, supervision.\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFunding was received by A.M. from the National Health Medical Research Council, Australia (NHMRC). The NHMRC was not involved in data collection, analysis or creation of this systematic review.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflicts of interest:\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere are no conflicts of interest that we are aware of.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eM.B.: conception and design, data collection and assembly, data interpretation and analysis, risk of bias assessment, manuscript writing and editing. K.Z.: literature searching, data collection and assembly, risk of bias assessment, manuscript writing. J.S.: data collection and assembly, risk of bias assessment, manuscript writing. E.P.: manuscript editing, supervision. A.K.: conception, manuscript editing. A.M.: conception and design, manuscript editing, supervision.\\u003c/p\\u003e\\u003ch2\\u003eAvailability of data and materials\\u003c/h2\\u003e \\u003cp\\u003eThe data that supports these findings is included within the article and as part of its additional files.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eBienstock J, Heuer A. A review on the evolution of simulation-based training to help build a safer future. Medicine (Baltimore). 2022;101(25):e29503. DOI: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/MD.0000000000029503\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/MD.0000000000029503\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCornthwaite K, Edwards S, Siassakos D. 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Effectiveness of interprofessional simulation-based education programs to improve teamwork and communication for students in the healthcare profession: A systematic review and meta-analysis of randomized controlled trials. Nurse Educ Today. 2023;120:105619. DOI: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.nedt.2022.105619\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.nedt.2022.105619\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKiessling A, Amiri C, Arhammar J, Lundb\\u0026auml;ck M, Wallingstam C, Wikner J, et al. Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations. J Interprof Care. 2022;36(6):873\\u0026ndash;81. DOI: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/13561820.2022.2038103\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/13561820.2022.2038103\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWikipedia (2024), File:BlankMap-World-v7.png [Image] \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://en.m.wikipedia.org/wiki/File:BlankMap-World-v7.png\\u003c/span\\u003e\\u003cspan address=\\\"https://en.m.wikipedia.org/wiki/File:BlankMap-World-v7.png\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Accessed April 21, 2025.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Emergency, medical education, neonatology, obstetrics, skills training\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6344547/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6344547/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBACKGROUND\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eInterprofessional (IP) simulation-based training (SBT) is a very important tool for enhancing multidisciplinary teamwork when managing obstetric and neonatal emergencies and emergencies in any medical speciality. While current evidence supports the role of IP SBT in improving practitioner collaboration and patient outcomes, systematic reviews to date have focused on SBT within individual specialties. We aimed to systematically review the prevalence and effectiveness of combined IP SBT in the management of obstetric and neonatal emergencies globally.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMETHODS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe conducted a systematic search of several databases (PubMed, EMBASE, CINAHL, MEDLINE) for relevant articles. Our search focused on looking at combined obstetric and neonatal IP SBT in a clinical education setting from inception to October 2024. The Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-1) tool was used to perform a risk of bias assessment for quantitative studies. The Joanna Briggs Institute (JBI) checklist was used risk of bias assessment of qualitative studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool to assess the certainty of available evidence.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRESULTS\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe found 6374 articles in our initial systematic search. Following screening, 40 studies met the inclusion criteria, involving healthcare professionals from 18 countries. The type of SBT programs varied, with the Obstetrics and Neonatal Emergency Simulation (ONE-Sim) program being the most common, reported in 7 studies. Other programs included Simulation and Team Training for Obstetric and Neonatal Emergencies (PRONTO), Enhancing Training and Technology for Mothers and Babies in Africa (ETATMBA) and Practical Obstetric Multi-Professional Training (PROMPT). The simulation programs usually consisted of several obstetric and neonatal emergency simulation scenarios which were followed by participant debrief. The included studies reflected on the simulation environment, practitioner reported outcomes such as clinician skills, leadership, knowledge, confidence, interprofessional teamwork, clinical and organisational outcomes. Using the GRADE approach there was an overall moderate certainty of evidence for the effectiveness of SBT in obstetric and neonatal emergencies.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCONCLUSION\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis review supports the need for increased availability and provision of IP SBT training across the globe. Despite current studies showing benefit in enhancing clinician skills, patient outcomes and organisational performance, the evidence on SBT programs for managing obstetric and neonatal emergencies remains limited and requires further research and implementation.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Interprofessional Simulation Based Training for Obstetric and Neonatal Emergencies: A Systematic Review\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-07 08:41:04\",\"doi\":\"10.21203/rs.3.rs-6344547/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"43416869-8051-4486-857c-6ef664f15e8b\",\"owner\":[],\"postedDate\":\"May 7th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-13T15:08:20+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-05-07 08:41:04\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6344547\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6344547\",\"identity\":\"rs-6344547\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}